Since the passage of the decentralization law, the fight against tuberculosis has been the responsibility of the departments. In this context, the health departments of the general councils of Guadeloupe, Martinique, and French Guiana work closely with a laboratory that centralizes all samples for mycobacterial testing: this is the Pasteur Institute in Guadeloupe and French Guiana, as well as the Departmental Hygiene Laboratory in Martinique. In addition, these three overseas departments benefit from the services of a regional reference laboratory for tuberculosis and atypical mycobacteria, located at the Pasteur Institute in Guadeloupe. This article describes the main results obtained through tuberculosis surveillance from 1994 to 1998.