The incidence of tuberculosis (TB) in the Russian Federation has increased steadily from 34 per 100,000 population in 1991 to 78 per 100,000 in 1998 (Central Tuberculosis Research Institute, unpublished data, 1999). To reverse this trend, in 1995, federal and local governments, with assistance from the World Health Organization (WHO), implemented a pilot project using the WHO TB-control strategy of directly observed therapy, short-course (DOTS) in Ivanovo oblast (1998 population: approximately 1.3 million), a district 165 miles (280 km) northeast of Moscow. This report documents a substantial increase in primary multidrug-resistant TB (P-MDRTB) in the civilian population of Ivanovo from January 1996 through October 1998 and a high prevalence of alcoholism, previous incarceration, unemployment, and history of homelessness among persons infected with both drug-susceptible and drug-resistant Mycobacterium tuberculosis strains.