Tuberculosis surveillance in France is based on mandatory reporting of active tuberculosis cases and treatment outcomes 12 months after treatment initiation. French Guiana is one of the three French regions with the highest reporting rates for active tuberculosis cases, along with Mayotte and Île-de-France. In 2017, the rate stood at 32.5 cases per 100,000 inhabitants, with cases concentrated mainly in Cayenne and its surrounding areas. As in mainland France, the epidemiological situation largely reflects recent migration patterns and incidence rates in countries of origin. In French Guiana, in 2016–2017, the majority of cases thus originated in Haiti, where political instability, natural disasters, and poverty drive migration and the spread of the bacillus; the country has the highest incidence rate in the Americas. The vast majority of diagnoses were made through direct access to the healthcare system, which calls for strengthening targeted screening efforts among these at-risk populations. Furthermore, the proportion of patients who completed their treatment remained below targets and did not change between 2012 and 2016, even though prompt and complete treatment is a key component of the fight against tuberculosis.