Redes sociais de pessoas com tuberculose em situação de rua: mapeamento social para atenção à saúde

Abstract

Introduction: Tuberculosis remains a major public health problem and disproportionately affects highly vulnerable groups, particularly people experiencing homelessness. Objectives: To map the structure of the primary and secondary social networks of people with tuberculosis experiencing homelessness; to identify the types of support provided by social networks for the treatment and control of tuberculosis; and to propose guidelines for Family Health Strategy teams and Street Outreach Clinics that enable the use of a social network approach in the care of people experiencing homelessness with tuberculosis. Method: This qualitative study was conducted through semi-structured interviews with 15 individuals diagnosed with tuberculosis who were receiving care at two primary health care units in Rio de Janeiro, Brazil, between December 2024 and March 2025. Data were analyzed using Bardin’s thematic content analysis technique. Results: The findings showed that the study participants (n = 15; aged 18–59 years) were predominantly male (80%), self-identified as mixed-race or Black (93.3%), and had low educational attainment (66.7% had completed only elementary education). Participants presented small and low-density primary social networks, characterized by a limited number of interpersonal relationships. They reported receiving support from their secondary social networks, composed mainly of health professionals who developed strategies focused on coping, welcoming care, and ensuring access to government social assistance and income-transfer programs. Conclusion: This study highlighted important aspects of how people experiencing homelessness perceive tuberculosis care within the context of their social relationships. Primary social networks were found to be fragile, whereas relationships with secondary networks facilitated the establishment of bonds with health professionals. Among the social support demands identified, material, financial, and emotional support were considered essential for overcoming challenges related to treatment. In situations of extreme vulnerability, tuberculosis treatment is often marked by interruptions and discontinuities, demonstrating the complexity of health care in the absence or fragility of social networks and in the presence of profound socioeconomic difficulties. Therefore, strengthening public policies that address the social networks of vulnerable populations should be prioritized within primary health care. Knowledge of social networks, as well as social support and care needs, constitutes an important tool for Family Health Strategy teams and Street Outreach Clinics, contributing to the successful control and cure of tuberculosis among people experiencing homelessness.