(Re)producing HIV Care for Ukrainian Refugees in Germany and Poland: Trans-Local Community-Based Support in Action

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for an opportunity to review this manuscript, which addresses a topic of huge importance and has the potential to provide a valuable contribution to the field. The manuscript may benefit from improved conceptualization, logical coherence and organization, and engagement with sources. My specific comments and questions are listed below.

Abstract:

1. You need to briefly describe your methods and include the N of conducted interviews. For example: "This qualitative study applied a Community-Based Participatory Research (CBPR) to examine (your research question here - it's currently lacking). The study used data from (N) semi-structured interviews with (...), conducted from ... to (dates of data collection). 
2. You don't need to describe the CBRP in the abstract, you can do that in Methods.
3. Add a brief description of data analysis methods to the Abstract. For example, "We applied a thematic analysis to identify emergent themes...." or similar.

Introduction

1. It's too long. You may want to break it into two parts: a) Introduction, focusing on the theoretical concepts and available scholarship, and b) Background, to provide detail on Ukrainian refugees influx, and health systems of Poland and Germany.
2. We believe that the central argument of the manuscript is the role of community-based organizations (CBOs), emerging and existing in the host countries, in facilitating access to care and services for Ukrainian refugees living with HIV, at risk of HIV, and exposed to TB. There is an abundant evidence on the role of CBOs in facilitating access to HIV care and other services. We suggest that you organize your manuscript around this concept and revise the sections of the paper accordingly. We believe that it is very important that your findings align with existing evidence from very diverse global settings. Moreover, Ukrainian refugees in precarious situations reproduce this grassroot system of CBOs and a whole range of support systems in the host countries. You need to engage this rich scholarship on the role of CBOs in HIV continuum of care - there are hundreds of published papers, and incorporate them in the Introduction. Just a few examples of publications:
   - Robillard AG, Julious CH, Smallwood SW, Douglas M, Gaddist BW, Singleton T. Structural Inequities, HIV Community-Based Organizations, and the End of the HIV Epidemic. Am J Public Health. 2022 Mar;112(3):417-425. doi: 10.2105/AJPH.2021.306688. PMID: 35196039; PMCID: PMC8887177.
   - Akeju, D., Nance, N., Salas-Ortiz, A. et al. Management practices in community-based HIV prevention organizations in Nigeria. BMC Health Serv Res 21, 489 (2021). https://doi.org/10.1186/s12913-021-06494-1
   - Marano-Lee M, Williams W, Uhl G, Eke A, Joshua T, Xu S, Carter J, Rakestraw A, Dunbar E. Contributions of Community-Based Organizations Funded by the Centers for Disease Control and Prevention's HIV Testing Program. J Public Health Manag Pract. 2022 Mar-Apr 01;28(2):E461-E466. doi: 10.1097/PHH.0000000000001446. PMID: 34608887.
   - Kouanfack C, Mvilongo M, Zemsi S, Fomete L, Mapa-Tassou C, Djam A, Zambou F, Ateudjieu J, Fouda PJ. Contribution of community-based organizations in the improvement of Joint United Nations Program on HIV and AIDS 90-90-90: case of the Yaoundé Central Hospital. Pan Afr Med J. 2023 Aug 21;45:173. doi: 10.11604/pamj.2023.45.173.38466. PMID: 37954437; PMCID: PMC10632170.

Materials and Methods:

1. Line 132: We believe that the CBPR better describes your approach. Please use these two original publications to integrate it in Methods:
   Wallerstein N, Duran B. Using community-based participatory reseach to address health disparities. Health Promotion Practice. 2006;7:312–323. doi: 10.1177/1524839906289376
   Wallerstein N, Duran B, Oetzel J, Minkler M. Community-based participatory research for health. 3rd. San Franciso: Jossey Bass; 2017.

3. Lines 149-162 - this belongs to Background, not Methods

4. Lines 163-165 - this research question belongs to Introduction.

5. Lines 169-173 - This is confusing. Please edit for clarity to specify the N of interviews with refugees, the N of expert interviews and add selection criteria for both types of interviews.  

6. Title of Table 1 - edit for clarity; it's confusing. For example: "Sociodemographic characteristics of interviewed Ukrainian refugees (N=35). We suggest adding a column with HIV or TB status and include categories like "PLWH" (person/people living with HIV), "at risk of HIV" (were all interviewed persons living with HIV? It's unclear in Lines 169-173), "treated TB" or similar.
Also, we suggest replacing "Sex" with "Gender" in headings.

7. Information lacking; please add: how long the interviews lasted; whether they were audio-recorded; where they were conducted; whether the participants signed an informed consent or provided an oral consent. 

8. Line 186-193 - it is unclear who conducted the interviews. Authors? Community leaders? If this is the case, specify, how you trained them in qualitative methods, data collection, and ethics.

9. Lines 197-203- this belongs to Background or Discussion

10. Line 205 - add an in-text reference for Atlas.ti (leading to the site of the proprietor). Also, Atlas is one of the widely-used software for qualitative analyses. You don't need to specify that is was used to manage data and make the analysis transparent.

11. Lines 203-213 - how did you develop the final codebook and who did the coding?

12. Lines 214 - 224 - this belongs to Background, not Methods.

Results:

These are my general concerns that apply to the whole Results section. It needs a significant revision and we cannot comment on the line-by-line basis because we don't want to end up with a hundred comments. Please consider the following and revise accordingly:
1. Open the Results section with a one-paragraph brief overview of emerging/most important themes that you want to discuss. If you follow our suggestion to conceptualize the manuscript around the role of CBOs, you may want to re-organize the way you present your findings/

2. Use quotations from interviews to illustrate these themes under each sub-heading. Adding the N of participants who evoked this theme is important. Also, quotes should align with a specific theme. For example, quote in Lines 243-247 describes how and why this woman arrived in Berlin. It does not speak to the theme "Overcoming barriers to HIV care"
3. Please describes your findings only in Results. You cannot use in-text references here - they belong to Discussion.

4. All findings should be substantiated and supported by quotes from participants' or expert interviews. Just one example in Lines 235-239: "undiagnosed stress", "trauma", "PTSD", "burnout" etc. - how do you know?! Did participants mention that? Where? It should become a very different theme then - maybe not relevant to your central argument, because this is mental health.

5. Gender dimensions and Prolonged uncertainty sub-sections - how do they relate to the themes of the role of CBOs in helping Ukrainians to access care? Use quotations from the interviews and revise accordingly.

6. Circular migration - how is it relevant to the central theme of the manuscript, the role of CBOs? Revise accordingly. 

7. Another consideration - the organization and presentation of your findings should align with the conceptualization of your paper. If you chose the role of CBOs as your central concept, you may want to re-organize your themes and revised sub-headings.

Discussion:

In many ways, Discussion reiterate your findings. However, the goal of Discussion is to integrate them to the theoretical concept and show your contribution to the field, as long as to discuss how your findings are consistent (or not) with evidence from similar and different settings. You may want to use the rich scholarship on the role of CBOs for HIV continuum of care and health equity. We discussed this literature earlier in our comments (see comments on Introduction).

Conclusions:

This section should be concise; one paragraph is usually enough. Please do not use in-text references in Conclusions. Include your major findings, theoretical contributions (in you wish) and recommendations for practice.

Overall, a very valuable study! We are looking forward to a revised version.

  

Comments on the Quality of English Language

The manuscript needs another round of editing to improve the quality of English. Some sentences or phrases are awkward; sometimes articles are missing; many paragraphs would benefit from editing for clarity.
A minor note - replace "interlocutors" with "study participants" or similar.

Author Response

Dear Reviewer,

Thank you very much for taking the time to review our manuscript and for your thoughtful comments. We sincerely appreciate your recognition of the significance of the topic, as well as your constructive suggestions for improvement. We are grateful for your specific comments and suggestions  for each part of the article. Please find our point-by-point responses below.We strongly hope the quality of the article has mich improved. Please, see detailed answers to your comments. Our changes are indicated in lines in the edited document entitled “MAJOR REVISIONS...”

Abstract:

1. You need to briefly describe your methods and include the N of conducted interviews. For example: "This qualitative study applied a Community-Based Participatory Research (CBPR) to examine (your research question here - it's currently lacking). The study used data from (N) semi-structured interviews with (...), conducted from ... to (dates of data collection).

 

Thank you for pointing this out. I/We agree with this comment. We adopted the suggested changed on p. 1, lines 7-11.

 

1. You don't need to describe the CBRP in the abstract, you can do that in Methods.

We agree with you. Details are in lines 163-172

1. Add a brief description of data analysis methods to the Abstract. For example, "We applied a thematic analysis to identify emergent themes...." or similar.

Thank you. Please, lines 241-248 for details of the data analysis.

Introduction

1. It's too long. You may want to break it into two parts: a) Introduction, focusing on the theoretical concepts and available scholarship, and b) Background, to provide detail on Ukrainian refugees influx, and health systems of Poland and Germany.

Thank you for this suggestion: we slightly reduced the whole introduction text and broke it down to two parts with sub-headings.  

1. We believe that the central argument of the manuscript is the role of community-based organizations (CBOs), emerging and existing in the host countries, in facilitating access to care and services for Ukrainian refugees living with HIV, at risk of HIV, and exposed to TB. There is an abundant evidence on the role of CBOs in facilitating access to HIV care and other services. We suggest that you organize your manuscript around this concept and revise the sections of the paper accordingly. We believe that it is very important that your findings align with existing evidence from very diverse global settings. Moreover, Ukrainian refugees in precarious situations reproduce this grassroot system of CBOs and a whole range of support systems in the host countries. You need to engage this rich scholarship on the role of CBOs in HIV continuum of care - there are hundreds of published papers, and incorporate them in the Introduction. Just a few examples of publications:
   - Robillard AG, Julious CH, Smallwood SW, Douglas M, Gaddist BW, Singleton T. Structural Inequities, HIV Community-Based Organizations, and the End of the HIV Epidemic. Am J Public Health. 2022 Mar;112(3):417-425. doi: 10.2105/AJPH.2021.306688. PMID: 35196039; PMCID: PMC8887177.
   - Akeju, D., Nance, N., Salas-Ortiz, A. et al. Management practices in community-based HIV prevention organizations in Nigeria. BMC Health Serv Res 21, 489 (2021). https://doi.org/10.1186/s12913-021-06494-1
   - Marano-Lee M, Williams W, Uhl G, Eke A, Joshua T, Xu S, Carter J, Rakestraw A, Dunbar E. Contributions of Community-Based Organizations Funded by the Centers for Disease Control and Prevention's HIV Testing Program. J Public Health Manag Pract. 2022 Mar-Apr 01;28(2):E461-E466. doi: 10.1097/PHH.0000000000001446. PMID: 34608887.
   - Kouanfack C, Mvilongo M, Zemsi S, Fomete L, Mapa-Tassou C, Djam A, Zambou F, Ateudjieu J, Fouda PJ. Contribution of community-based organizations in the improvement of Joint United Nations Program on HIV and AIDS 90-90-90: case of the Yaoundé Central Hospital. Pan Afr Med J. 2023 Aug 21;45:173. doi: 10.11604/pamj.2023.45.173.38466. PMID: 37954437; PMCID: PMC10632170.

Thanks for these relevant articles, we included these references into the introduction part.

Materials and Methods:

1. Line 132: We believe that the CBPR better describes your approach. Please use these two original publications to integrate it in Methods:
   Wallerstein N, Duran B. Using community-based participatory reseach to address health disparities. Health Promotion Practice. 2006;7:312–323. doi: 10.1177/1524839906289376
   Wallerstein N, Duran B, Oetzel J, Minkler M. Community-based participatory research for health. 3rd. San Franciso: Jossey Bass; 2017.

Thanks for these relevant references, we included them, line 160

2. Lines 149-162 - this belongs to Background, not Methods

We addressed that having moved this information to the last abstract of the introduction (lines 129 - 136)

4. Lines 163-165 - this research question belongs to Introduction. Addressed.
5. Lines 169-173 - This is confusing. Please edit for clarity to specify the N of interviews with refugees, the N of expert interviews and add selection criteria for both types of interviews.

Addressed in lines 185-189 on the new version.

6. Title of Table 1 - edit for clarity; it's confusing. For example: "Sociodemographic characteristics of interviewed Ukrainian refugees (N=35). We suggest adding a column with HIV or TB status and include categories like "PLWH" (person/people living with HIV), "at risk of HIV" (were all interviewed persons living with HIV? It's unclear in Lines 169-173), "treated TB" or similar.

Also, we suggest replacing "Sex" with "Gender" in headings.

Addressed in tables.

7. Information lacking; please add: how long the interviews lasted; whether they were audio-recorded; where they were conducted; whether the participants signed an informed consent or provided an oral consent.

Addressed in lines 193-195

8. Line 186-193 - it is unclear who conducted the interviews. Authors? Community leaders? If this is the case, specify, how you trained them in qualitative methods, data collection, and ethics.

Added in lines 206- 211

9. Lines 197-203- this belongs to Background or Discussion

Deleted for the sake of brevity

10. Line 205 - add an in-text reference for Atlas.ti (leading to the site of the proprietor). Also, Atlas is one of the widely-used software for qualitative analyses. You don't need to specify that is was used to manage data and make the analysis transparent.
11. Lines 203-213 - how did you develop the final codebook and who did the coding?

Thank you, that was addressed in Lines 241-248

12. Lines 214 - 224 - this belongs to Background, not Methods.

Addressed – moved to becomr the last paragraph in the introduction. 

Results:

These are my general concerns that apply to the whole Results section. It needs a significant revision and we cannot comment on the line-by-line basis because we don't want to end up with a hundred comments. Please consider the following and revise accordingly:
1. Open the Results section with a one-paragraph brief overview of emerging/most important themes that you want to discuss. If you follow our suggestion to conceptualize the manuscript around the role of CBOs, you may want to re-organize the way you present your findings/

Addressed in the first paragraph of Results.

2. Use quotations from interviews to illustrate these themes under each sub-heading. Adding the N of participants who evoked this theme is important. Also, quotes should align with a specific theme. For example, quote in Lines 243-247 describes how and why this woman arrived in Berlin. It does not speak to the theme "Overcoming barriers to HIV care"

Thank you, you are right about this quotation. I expanded it to demonstrate the theme clearer.  

3. Please describes your findings only in Results. You cannot use in-text references here - they belong to Discussion.

We addressed that – We moved out all the references either to the discussion or to introduction.

4. All findings should be substantiated and supported by quotes from participants' or expert interviews. Just one example in Lines 235-239: "undiagnosed stress", "trauma", "PTSD", "burnout" etc. - how do you know?! Did participants mention that? Where? It should become a very different theme then - maybe not relevant to your central argument, because this is mental health.

We extended the number of relevant quotations to back up our claims and thecked them all for consistency and relevance to the claimed themes.

5. Gender dimensions and Prolonged uncertainty sub-sections - how do they relate to the themes of the role of CBOs in helping Ukrainians to access care? Use quotations from the interviews and revise accordingly.
6. Circular migration - how is it relevant to the central theme of the manuscript, the role of CBOs? Revise accordingly.

Thank you, very important comment. For both of the above mentioned themes we tried to link them with the way how communities address the barriers we discuss.  

7. Another consideration - the organization and presentation of your findings should align with the conceptualization of your paper. If you chose the role of CBOs as your central concept, you may want to re-organize your themes and revised sub-headings.

Thank you. We restructured the analysis and adjusted the heading to reflect the central role of CBOs.

Discussion:

In many ways, Discussion reiterate your findings. However, the goal of Discussion is to integrate them to the theoretical concept and show your contribution to the field, as long as to discuss how your findings are consistent (or not) with evidence from similar and different settings. You may want to use the rich scholarship on the role of CBOs for HIV continuum of care and health equity. We discussed this literature earlier in our comments (see comments on Introduction).

I hope it looks more coherent now.

 

Conclusions:

This section should be concise; one paragraph is usually enough. Please do not use in-text references in Conclusions. Include your major findings, theoretical contributions (in you wish) and recommendations for practice.

Rewrote the conclusions. Thanks once again for taking time to carefully read our paper and suggest details recommendations that greatly helped us to improve it.

Overall, a very valuable study! We are looking forward to a revised version.

 

 

Comments on the Quality of English Language

The manuscript needs another round of editing to improve the quality of English. Some sentences or phrases are awkward; sometimes articles are missing; many paragraphs would benefit from editing for clarity.
A minor note - replace "interlocutors" with "study participants" or similar.

We did a language check, thank you!  

Submission Date

22. 08. 2025

 

Reviewer 2 Report

Comments and Suggestions for Authors

In the last sentence of the Introduction (lines 126-128), the term “migrant organizations” is used (“The role of migrant organizations in overcoming these barriers is highlighted, with a concluding discussion on their vital contribution to community-based HIV care linkage”).

Given that the focus of the paper is specifically on refugees from Ukraine, I would suggest revising this wording for precision. Using “refugee-support organizations” or “organizations supporting refugees” may be more appropriate and consistent with the framing and focus of the study.

Given that the Methods section highlights the participatory action approach and strong community engagement (including references such as Baum et al. 2006 and Israel et al. 1998), it would strengthen the paper to more clearly situate this approach in the Introduction.

Specifically, it would be beneficial to include references to participatory health research (PHR) approaches in the European region for refugee and migrant health. This would help position the study within existing regional practices and underscore the relevance of PHR for addressing health access challenges among refugee populations.

The Material and Methods section currently contains important contextual information about refugee numbers, country selection rationale, and the emergence of patient grassroots organizations (particularly in Poland and Germany). While these details are valuable, they read more as background or justification than as methods.

For clarity and consistency with standard article structure, consider moving the following lines to the Introduction section:

• Lines 148–162 (starting with “Poland and Germany were selected as focal countries...” through “had to either contact healthcare facilities directly (France) or rely on the support of local civil society organizations (Estonia, Georgia, Moldova).”)

These sentences justify country selection and describe refugee population figures and patterns of civil society support – which are excellent for setting the scene in the Introduction.

Meanwhile, the Methods section could then focus more cleanly on describing your study design, participatory approach, sampling, ethics, and data collection.

Additionally, the Material and Methods section includes content that appears more appropriate for the Results section. In particular, lines 153–158 (“Our preliminary observations revealed…”) report empirical findings about the emergence of grassroots patient organizations, which are analytical results rather than methodological detail.

I recommend relocating these sentences to the Results section to maintain clear separation between describing the research approach and presenting what was discovered.

Reorganizing this way will help readers quickly find the empirical methods and make the paper’s structure more intuitive.

The title “Table 1. Brief description of people with people on the move” is confusing and redundant. I recommend revising it for clarity.

I noticed that the terms “migrant” and “refugee” are sometimes used interchangeably in the manuscript. Given the specific legal and social distinctions between these categories, I suggest reviewing the text carefully to ensure consistent and accurate use of terminology throughout. Clarifying these terms where necessary will improve the precision and credibility of the analysis.

In the section starting at line 243, the text includes direct quotations from interview participants, but this is not visually marked in a way that clearly distinguishes it from the main narrative. I suggest formatting these participant quotes in italics, indentation, or quotation blocks to make them easily recognizable for the reader. This will improve readability and help emphasize the qualitative, participant-led nature of these insights.

I recommend adding a Limitations section that acknowledges, for example, the narrow geographic focus (Germany and Poland), possible selection and confirmation bias in participatory interviews, and the exclusive focus on HIV care which may not capture broader refugee health needs. Also, note that findings may be time-bounded given rapidly evolving policy contexts.

 

 

 

Comments on the Quality of English Language

A few typos require attention. I would suggest carefully revising the text.

Author Response

Dear Reviewer,
Thank you very much for taking the time to review our manuscript and for your thoughtful comments. We sincerely appreciate your recognition of the significance of the topic, as well as your constructive suggestions for improvement. We are grateful for your specific comments and suggestions  for each part of the article. Please find our point-by-point responses below.We strongly hope the quality of the article has mich improved.

Our changes are indicated in lines in the edited document entitled “MAJOR REVISIONS...”

 

In the last sentence of the Introduction (lines 126-128), the term “migrant organizations” is used (“The role of migrant organizations in overcoming these barriers is highlighted, with a concluding discussion on their vital contribution to community-based HIV care linkage”).

Given that the focus of the paper is specifically on refugees from Ukraine, I would suggest revising this wording for precision. Using “refugee-support organizations” or “organizations supporting refugees” may be more appropriate and consistent with the framing and focus of the study.

We addressed that in line 139.

Given that the Methods section highlights the participatory action approach and strong community engagement (including references such as Baum et al. 2006 and Israel et al. 1998), it would strengthen the paper to more clearly situate this approach in the Introduction.

Specifically, it would be beneficial to include references to participatory health research (PHR) approaches in the European region for refugee and migrant health. This would help position the study within existing regional practices and underscore the relevance of PHR for addressing health access challenges among refugee populations.

Thank you for this valuable suggestion. We have now positioned our study within the European participatory health research (PHR) context by adding a reference to recent work on participatory approaches to refugee and migrant health in the EU (Pratsiv et al. 2020) and clarifying how our project aligns with these practices (see lines 169–172).

The Material and Methods section currently contains important contextual information about refugee numbers, country selection rationale, and the emergence of patient grassroots organizations (particularly in Poland and Germany). While these details are valuable, they read more as background or justification than as methods.

For clarity and consistency with standard article structure, consider moving the following lines to the Introduction section:

• Lines 148–162 (starting with “Poland and Germany were selected as focal countries...” through “had to either contact healthcare facilities directly (France) or rely on the support of local civil society organizations (Estonia, Georgia, Moldova).”)

These sentences justify country selection and describe refugee population figures and patterns of civil society support – which are excellent for setting the scene in the Introduction.

Following your advice we replace this section to introduction (see lines 129 – 140)

Meanwhile, the Methods section could then focus more cleanly on describing your study design, participatory approach, sampling, ethics, and data collection.

Additionally, the Material and Methods section includes content that appears more appropriate for the Results section. In particular, lines 153–158 (“Our preliminary observations revealed…”) report empirical findings about the emergence of grassroots patient organizations, which are analytical results rather than methodological detail.

I recommend relocating these sentences to the Results section to maintain clear separation between describing the research approach and presenting what was discovered.

Reorganizing this way will help readers quickly find the empirical methods and make the paper’s structure more intuitive.

Thank you for pointing this out. Following your advice, we have revised the section and moved these lines, which describe the emergence of grassroots patient organizations, from the Materials and Methods to the Introduction (see revised manuscript, lines 153–160) rephrasing to fit appropriately as the background information.

The title “Table 1. Brief description of people with people on the move” is confusing and redundant. I recommend revising it for clarity.

Thank you very much, Addressed.

 

I noticed that the terms “migrant” and “refugee” are sometimes used interchangeably in the manuscript. Given the specific legal and social distinctions between these categories, I suggest reviewing the text carefully to ensure consistent and accurate use of terminology throughout. Clarifying these terms where necessary will improve the precision and credibility of the analysis.

Thank you for this important observation. We carefully revised the manuscript throughout to ensure accurate and consistent use of the terms migrant and refugee, respecting their specific legal and social distinctions. Where necessary, we clarified terminology to strengthen the precision and credibility of the analysis.

 

In the section starting at line 243, the text includes direct quotations from interview participants, but this is not visually marked in a way that clearly distinguishes it from the main narrative. I suggest formatting these participant quotes in italics, indentation, or quotation blocks to make them easily recognizable for the reader. This will improve readability and help emphasize the qualitative, participant-led nature of these insights.

I recommend adding a Limitations section that acknowledges, for example, the narrow geographic focus (Germany and Poland), possible selection and confirmation bias in participatory interviews, and the exclusive focus on HIV care which may not capture broader refugee health needs. Also, note that findings may be time-bounded given rapidly evolving policy contexts.

We added a separate limitation section, thanks for this important suggestion.

22.08.2025

Reviewer 3 Report

Comments and Suggestions for Authors

OVERALL

Thank you for this very interesting and important paper that I enjoyed reading. It addresses a key topic, and I was pleased to see the participatory approach taken by the research.

The paper reports details of an interesting perspective on the need to continue HIV support services for Ukrainian migrants forced to flee conflict in their own country. I appreciated the focus on civil society, information networks, and the additional factors you addressed such as gender issues and circular migration for health reasons.

I’ve only relatively minor comments that I include in each section below.

I have one comment on the reference list – this is currently in an odd layout, with extra names and years in brackets which will need removing before publication.

INTRODUCTION

This section provides useful background to the topic, focusing the challenges faced by migrants living with HIV being forced to relocate and integrate with another health system.

My only very minor comment here is that I would recommend avoiding the use of ‘etc.’ in lists.

MATERIALS AND METHODS

The methods of data collection are well-described here, and it’s clear that you collected a range of useful data. I also appreciate the multiple sources of information from several different types of sources.

It might be useful to have a little more information about how the interviews were conducted, and the nature of the questions. Also, I do note that the study received ethical approval, but information about how you obtained consent from participants would be useful.

RESULTS

There are some interesting findings here. I was especially interested in the way that Ukrainians themselves created collectively mechanisms for peer support and information sharing. The gender aspect is crucially important, and I note that the role of women is central to the development of new networks for migrants living with HIV (and other diseases requiring consistent treatment).

I was also intrigued by the issues around circular migration – this is a ‘thing’ for migration generally of course, but usually in the context of employment. I’m pleased this is highlighted here as something more focusing on health.

A minor point, but I’d recommend italicising excerpts from your interviews – it enables easier reading.

DISCUSSION/CONCLUSION

You draw your findings together here and make some strong points about the three organisation types shown in your data. Your recommendations are highly relevant for practice and for health policy planning.

It would be useful here to add any limitations that you see in your study.

REVIEWER RECOMMENDATIONS

1. Avoid using ‘etc.’ in the text.
2. Add a little more detail about how the interviews (and other data collection activities) were conducted.
3. Add information about informed consent – how was this obtained from participants?
4. Consider italicising interview excerpts.
5. Add limitations that you see in your study.

Author Response

Thank you so much for your kind and thoughtful feedback. It truly means a lot to me that you found the paper both interesting and important. I am especially glad that the participatory approach and the focus on civil society, information networks, gender, and health-related mobility resonated with you. Your words are very encouraging and give me great motivation Our changes are indicated in lines in the edited document entitled “MAJOR REVISIONS...”

 to continue this line of work.

 

I’ve only relatively minor comments that I include in each section below.

I have one comment on the reference list – this is currently in an odd layout, with extra names and years in brackets which will need removing before publication.

We followed the standard reference style recommended by the journal. The first bracket will be removed by the editor.  

INTRODUCTION

This section provides useful background to the topic, focusing the challenges faced by migrants living with HIV being forced to relocate and integrate with another health system.

My only very minor comment here is that I would recommend avoiding the use of ‘etc.’ in lists.

Addressed this. Thank so much

MATERIALS AND METHODS

The methods of data collection are well-described here, and it’s clear that you collected a range of useful data. I also appreciate the multiple sources of information from several different types of sources.

It might be useful to have a little more information about how the interviews were conducted, and the nature of the questions. Also, I do note that the study received ethical approval, but information about how you obtained consent from participants would be useful.

Great comment. Thank you, we added a paragraph (lines 216 – 232)

RESULTS

There are some interesting findings here. I was especially interested in the way that Ukrainians themselves created collectively mechanisms for peer support and information sharing. The gender aspect is crucially important, and I note that the role of women is central to the development of new networks for migrants living with HIV (and other diseases requiring consistent treatment).

I was also intrigued by the issues around circular migration – this is a ‘thing’ for migration generally of course, but usually in the context of employment. I’m pleased this is highlighted here as something more focusing on health.

A minor point, but I’d recommend italicising excerpts from your interviews – it enables easier reading.

We did that. Thank you!

DISCUSSION/CONCLUSION

You draw your findings together here and make some strong points about the three organisation types shown in your data. Your recommendations are highly relevant for practice and for health policy planning.

It would be useful here to add any limitations that you see in your study.

Added!

REVIEWER RECOMMENDATIONS

1. Avoid using ‘etc.’ in the text. – done!
2. Add a little more detail about how the interviews (and other data collection activities) were conducted. – added.
3. Add information about informed consent – how was this obtained from participants? – added
4. Consider italicising interview excerpts. – added
5. Add limitations that you see in your stud – added

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

1. Introduction, Line 8 - after you first spell out community-based organizations, add (CBO) in brackets. Use the CBOs abbreviation throughout the manuscript for brevity.

2. Line 11 - you do not include the document analysis in Methods section of the paper. Consider removing it from Introduction as unnecessary - you surely analyzed policy documents and statistics to provide the context of an unfolding refugee crisis, but any stud does that and you don't need to include this in Methods. Your study uses primary data from qualitative interviews and this is your primary methods. Alternatively, you will need to provide specific detail in Methods. Please note that "document analysis" needs an article "the" before it.

3. Introduction, Lines 102-103. This sentence is unclear: "While ethnicity is often emphasized in migration and health research, discrimination and racism faced by refugees receive less attention, though HIV activists within displaced populations increasingly address these issues." Please revise - "while" and "though" do not work well together here. Consider breaking into two sentences and editing.

4. Lines 115-116 - see above. We suggest introducing the CBOs abbreviation in Abstract when you first spell it, and later use CBOs throughout the text.

5. Line 141 - NGOs or CBOs? If you want to use NGOs, spell it at first use. Yet, we recommend to use CBOs throughout the text for consistency.

6. Line 712 - something is missing here when you just say "Studies". You can replace with "Evidence from Germany suggests that...." or similar.

7. Last paragraph from Line 729 - data on the number of Ukrainian refugees in Germany and Poland does not belong here. Move these numbers to respective paragraphs about Germany and Poland above along with why these settings were chosen for your study.

8. Last paragraph from Line 729 - this paragraph should introduce significance of your study and research questions you aim to answer. Sheer volume of immigrants - the largest number of refugees in Poland and Germany - does not make your study significant. Significance is what gap you seek to address? For example, did any study previously address the role of Ukrainian CBOs is access to services? Please reflect on the unique contributions that you study make in the field of public health and refugee studies and revise the last paragraph accordingly.

9. Line 1334: "Interviews for this study were conducted in two formats: focusing on professional expertise and on patient experience." Two formats is unclear. You can say something like "Interviews with people living with HIV, TB, or at risk of HIV focused on the lived experiences and access to care in the context of relocation. Expert interviews with....focused on their ....."

10. Methods include information that belongs to Results and Background. Most information starting from Line 1337 - sociodemographic characteristics of participants and experts as well as Table 1 and Table 2 should be moved to results. The last paragraph from Line 1766 should be moved to Background.

11. Line 1731 - what do you mean "engaged in"? I understand that the authors did not conduct the interviews themselves, but this is totally fine. You just need to elaborate. Something like: "XX, XXX, and XXXX (initials of the authors) used a participatory approach to develop the interview guide and refine it using feedback from Ukrainian CBO members and refugees. The interviews were conducted by CBOs members and activists, who received training in qualitative data collection and principles of ethical research."

12. My previous comments on Methods; this info is still lacking:

a. Were respondents compensated for their time and participation? If yes, how/in what form? If no, add this to the text.

b. "Conversations were held in Ukrainian, Russian, German and English, depending on the interviewee's preference" - in what language did you conduct the analysis? Who transcribed the interviews? How were the transcripts translated? Also, move all this info into the same paragraph - it is now scattered across Methods.

c. Line 1761 - How about development of the codebook and coding? These are missing in this paragraph.

d. Did I understand correctly that participants provided an oral consent, which was recorded using an audio-recorder? Does it hold to expert interviews? Edit for clarity the respective paragraph and add this information.

e. What was the physical location of interviews (private rooms in CBO offices, etc)? How was confidentiality ensured?

13. Line 1266 - do not spell out CBOs again - you should first spell this abbreviation in Abstract

14. Line 1266 - "shaped by Ukrainian refugees" - unclear what you mean. Developed by Ukrainian refugees? Catering to the needs of Ukrainian refugees?

15. Line 2028 - "These gaps can be understood as both individual and structural barriers." Consider editing. Better say something like "Our analysis showed how a combination of individual, relational, and structural factors shape barriers to access HIV care". Swap sentences - first discuss barriers, then how activists address them.

16. Line 2092 - this relates to all quotes. Add gender, age and status to quotes, do not just refer the reader to the Table. For example "Participant 13, 43-year-old female, PWHV". I also suggest assigning different numbers to participants and experts - each starting with 1. The next quote it will then be "Expert XXX, XX-year-old male, social worker".

17. Discussion, Line 2699 - "by identifying a typology of organizations supporting HIV-positive individuals fleeing the Russian war in Ukraine". A few considerations - the goal of your study was not to "identify a typology." You study aimed to explore the ROLE of CBOs in bridging critical gaps in access to care for Ukrainian refugees. Thus, you need to link Discussion to your aims and research questions. As mentioned above, I encourage you to reflect and define them more clearly in the last paragraph of Introduction. In Discussion, the types of CBOs are out of place. You need to embed you findings in a broader scholarship on the essential roles of CBOs globally, which you added to Introduction, and show how you findings are consistent with (or different) this scholarship. Then, speak about your unique contributions - that you study examined (was the first to examine?) how in the context of an unfolding humanitarian and public heath crisis, grassroot activism and CBOs emerge as support systems, facilitating access to services and care. Overall, I suggest that you check out how your paper is organized and structured to make sure all pieces fit well together.  

Author Response

review_round 2

 

Comments and Suggestions for Authors

Dear Reviewer,

Thank you very much for taking the time to review our revised manuscript and for your thoughtful comments. Please find our point-by-point responses below.

We understand there may have been some confusion regarding the line indications in the file you worked with. We have done our best to address your comments accordingly.

These are our round-2 changes, and we believe they have significantly improved the quality of the article. Please see our detailed answers to your comments. Our revisions are indicated with line numbers in the edited document entitled “minor_revisions_socsci-3735534

1. Introduction, Line 8 - after you first spell out community-based organizations, add (CBO) in brackets. Use the CBOs abbreviation throughout the manuscript for brevity.

Thank you, we added it on p. 1, line 8. The abbreviation might be also found further: key words – p.1, line 25; p.3, line 136; p.6, line 196; p.11, line 450; p.12, line 473; p.15, line 623.

2. Line 11 - you do not include the document analysis in the Methods section of the paper. Consider removing it from Introduction as unnecessary - you surely analyzed policy documents and statistics to provide the context of an unfolding refugee crisis, but any stud does that and you don't need to include this in Methods. Your study uses primary data from qualitative interviews and this is your primary methods. Alternatively, you will need to provide specific detail in Methods. Please note that "document analysis" needs an article "the" before it.

Thanks for noticing. The mention of ‘document analysis’ has been removed as unnecessary.

3. Introduction, Lines 102-103. This sentence is unclear: "While ethnicity is often emphasized in migration and health research, discrimination and racism faced by refugees receive less attention, though HIV activists within displaced populations increasingly address these issues." Please revise - "while" and "though" do not work well together here. Consider breaking into two sentences and editing.

We thank the reviewer for this valuable suggestion. The sentence in question has been divided into two shorter sentences, and the wording has been edited for clarity.

4. Lines 115-116 - see above. We suggest introducing the CBOs abbreviation in Abstract when you first spell it, and later use CBOs throughout the text.

Done.

5. Line 141 - NGOs or CBOs? If you want to use NGOs, spell it at first use. Yet, we recommend to use CBOs throughout the text for consistency.

We use the term ‘community-based organisations’ (CBOs) to refer to our participants, as they represent grassroots initiatives. When we use the term ‘NGOs,’ we refer to more established organisations, which do not necessarily operate on a peer-to-peer basis. 

The spelling of NGOs is added. Thanks! 

6. Line 712 - something is missing here when you just say "Studies". You can replace with "Evidence from Germany suggests that...." or similar.

Thank you for noticing this, we adopted the change on p.2, line 47 and p. 3, line 113-114.

7. Last paragraph from Line 729 - data on the number of Ukrainian refugees in Germany and Poland does not belong here. Move these numbers to respective paragraphs about Germany and Poland above along with why these settings were chosen for your study.

Done.

8. Last paragraph from Line 729 - this paragraph should introduce significance of your study and research questions you aim to answer. Sheer volume of immigrants - the largest number of refugees in Poland and Germany - does not make your study significant. Significance is what gap you seek to address? For example, did any study previously address the role of Ukrainian CBOs is access to services? Please reflect on the unique contributions that you study make in the field of public health and refugee studies and revise the last paragraph accordingly.

please, see the revised two paragraphs - line 100-109, we wanted to make a clearly articulated link between the choice of countries and the research question. 

9. Line 1334: "Interviews for this study were conducted in two formats: focusing on professional expertise and on patient experience." Two formats is unclear. You can say something like "Interviews with people living with HIV, TB, or at risk of HIV focused on the lived experiences and access to care in the context of relocation. Expert interviews with....focused on their ....."
   
   Very important suggestion that will help us have more clarity in lines 168 - 171. 
10. Methods include information that belongs to Results and Background. Most information starting from Line 1337 - sociodemographic characteristics of participants and experts as well as Table 1 and Table 2 should be moved to results. The last paragraph from Line 1766 should be moved to Background.

Done. We moved sociodemographic characteristics of participants and experts and both tables to the Results section. 

The last paragraph was moved to Background.

11. Line 1731 - what do you mean "engaged in"? I understand that the authors did not conduct the interviews themselves, but this is totally fine. You just need to elaborate. Something like: "XX, XXX, and XXXX (initials of the authors) used a participatory approach to develop the interview guide and refine it using feedback from Ukrainian CBO members and refugees. The interviews were conducted by CBOs members and activists, who received training in qualitative data collection and principles of ethical research."

addressed in lines 224-232

12. My previous comments on Methods; this info is still lacking:
13. Were respondents compensated for their time and participation? If yes, how/in what form? If no, add this to the text.

added in lines 236-238

1. "Conversations were held in Ukrainian, Russian, German and English, depending on the interviewee's preference" - in what language did you conduct the analysis? Who transcribed the interviews? How were the transcripts translated? Also, move all this info into the same paragraph - it is now scattered across Methods.

All added to methods. We restructured the methods section to make the parts coherent. 

1. Line 1761 - How about development of the codebook and coding? These are missing in this paragraph.

Added into the Materials and Methods section.

1. Did I understand correctly that participants provided an oral consent, which was recorded using an audio-recorder? Does it hold to expert interviews? Edit for clarity the respective paragraph and add this information.
2. What was the physical location of interviews (private rooms in CBO offices, etc)? How was confidentiality ensured?

addressed in lines 188 - 205 

13. Line 1266 - do not spell out CBOs again - you should first spell this abbreviation in Abstract

Done.

14. Line 1266 - "shaped by Ukrainian refugees" - unclear what you mean. Developed by Ukrainian refugees? Catering to the needs of Ukrainian refugees?

Changed.

15. Line 2028 - "These gaps can be understood as both individual and structural barriers." Consider editing. Better say something like "Our analysis showed how a combination of individual, relational, and structural factors shape barriers to access HIV care". Swap sentences - first discuss barriers, then how activists address them.

Done.

16. Line 2092 - this relates to all quotes. Add gender, age and status to quotes, do not just refer the reader to the Table. For example "Participant 13, 43-year-old female, PWHV". I also suggest assigning different numbers to participants and experts - each starting with 1. The next quote it will then be "Expert XXX, XX-year-old male, social worker". 

Thank you for the suggestion, we adopted it by adding columns with numbers to participants and experts. 

17. Discussion, Line 2699 - "by identifying a typology of organizations supporting HIV-positive individuals fleeing the Russian war in Ukraine". A few considerations - the goal of your study was not to "identify a typology." You study aimed to explore the ROLE of CBOs in bridging critical gaps in access to care for Ukrainian refugees. Thus, you need to link Discussion to your aims and research questions. As mentioned above, I encourage you to reflect and define them more clearly in the last paragraph of Introduction. In Discussion, the types of CBOs are out of place. You need to embed you findings in a broader scholarship on the essential roles of CBOs globally, which you added to Introduction, and show how you findings are consistent with (or different) this scholarship. Then, speak about your unique contributions - that you study examined (was the first to examine?) how in the context of an unfolding humanitarian and public heath crisis, grassroot activism and CBOs emerge as support systems, facilitating access to services and care. Overall, I suggest that you check out how your paper is organized and structured to make sure all pieces fit well together.  

The paper was carefully reread and the discussion restructured to directly respond to the introduction and to reflect the key themes that emerged from the analysis. This restructuring ensures a coherent narrative flow, linking the study’s aims and research questions with findings and their broader scholarly context. 

 

Submission Date

02 Sept. 2025

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for addressing our comments and concerns. We believe that they were sufficiently addressed and that revisions have improved the manuscript's quality.

One more minor edit to complete:

Please remove an indication of Expert 12 specific role from the respective quote on p.18. The words "HelpNow helpline..." make this person identifiable. That would be enough to say "Expert 12, female (age), social worker" or similar.