Setting

uMgungundlovu District is located in central KwaZulu-Natal province. With a population of approximately one million people, the District reports 40% unemployment [19] with 112 000 people living on less than US$1 per day [20]. The District has an ante-natal HIV prevalence of 40.7% [19], and a TB incidence rate of 894 per 100 000 population [21,22]. Tuberculosis is the leading cause of death and of years of life lost in the District [19]. Eighty-four percent of the population does not have private healthcare insurance [19]. During the period of study, approximately 30% of the District was under 15 years of age and 65% were between the ages of 15 and 65 years of age, and there were 92 males for every 100 females [22]. Eight-five percent of the District is of African descent, among which 76.4% report isiZulu as their home language [20].