Evaluating the social capital and preferences for socioeconomic support of people living with tuberculosis in 32 impoverished communities in Lima, Peru: a qualitative study

Background: Tuberculosis (TB) is described as a social disease linked with poverty, marginalisation, social isolation and loneliness. These factors cause low social capital which predicts poor health. To end TB, national TB programmes (NTP) increasingly are aiming to tackle social inequalities exacerbating TB illness. However, NTP interventions aiming to increase social capital are limited and there is a lack of qualitative research, involving people living with tuberculosis (PTB), characterising their preferences for socioeconomic interventions. Methods: We conducted a qualitative study exploring the social capital and preferences for future socioeconomic interventions of PTB in 32 impoverished communities surrounding Lima, Peru. Convenience sampling identified 24 NTP-registered PTB including drug-sensitive TB, multidrug-resistant TB, pulmonary and extra-pulmonary TB who were invited for and participated in semi-structured interviews (SSIs) conducted in local health centres or their residences from April to May 2025. All SSIs were conducted in Spanish by a trained interviewer with written field notes by an observer and real-time sense checking of understanding. Transcripts were translated into English, collated in a codebook, and evaluated using thematic analysis. Results: Participants had median age 32 years (IQR=26-44) and 54% (13/24) were male. Participants were interviewed median 46 days (SD=47) following TB treatment initiation. SSIs lasted mean 38 minutes (range 21-68). Quality of social connections was reported as much more meaningful to PTB than quantity. Family, followed by friends, were the most common sources of support to PTB through personal social networks. When asked to name the support type most important to individual PTB, emotional support was most commonly cited. Religion provided the main community-based support for PTB, through hearing or listening to the word of God. PTB reported high community mistrust associated with neighbourhood insecurity. PTB also reported a desire for more comprehensive NTP campaigns to improve community education on TB type, severity, transmission, care and prevention. Conclusion : In impoverished communities of Lima, Peru, PTB relied primarily on support from family and friends; reporting high community mistrust and insecurity. Interventions that strengthen community TB education and government policies addressing neighbourhood security could increase community-based social capital to improve TB-related health outcomes. Trial registration: Not applicable.