The tuberculosis (TB) epidemic is historically anchored in South Africa’s Western Cape province, and long precedes the HIV epidemic. This is despite the generally better socio-economic status of the population and greater overall healthcare expenditure in this region than in other provinces. Contributing factors include overcrowding, alcohol abuse, poverty, and administrative neglect of the National TB Programme (NTP).1 This traditional ‘Cape’ epidemic is now being significantly augmented by an HIVassociated TB epidemic. Multidrug-resistant TB (MDR-TB), defined as disease caused by strains with resistance to at least isoniazid and rifampin,2 was first identified in the Western Cape in 1985; within nine years, MDR-TB accounted for 2% of TB isolates in this There.
