According to the World Health Organisation South Africa has the third highest tuberculosis (TB) incidence in the world, with an estimated 60 % incident cases having both TB and HIV. The South African National Tuberculosis Association (SANTA) recognized the importance of nutrition in the prevention and management of TB by including feeding schemes in community outreach programs. Vitamin D enhances innate immunity against mycobacterial infection through the antimicrobial peptide, cathelicidin. We reviewed studies on vitamin D status, its link with TB, and potential use in therapy in multiethnic South Africa with sunlight as primary source of vitamin D. Ethnicity, season, disease state, latitude, and urbanization are critical factors to be considered in vitamin D supplementation for prevention and treatment of TB.