Paris is by far the hardest-hit department in France, with an incidence rate 4.5 times higher than the national average. Although its population accounts for only one-thirtieth of France’s total population, the number of annual tuberculosis cases there represents 20% of the national total. In response to this situation, the Tuberculosis Control Service (SLAT) of the Paris department has undergone a restructuring. A tuberculosis coordination unit, created in June 2002, now enables the centralization of reported cases, the facilitation of screening investigations and their evaluation, the analysis and adaptation of targeted screening strategies in at-risk populations, and local epidemiological surveillance in at-risk communities and populations. Within the Directorate of Social Action for Children and Health (DASES), this unit coordinates the activities of the five Medical-Social Centers spread across the Paris region. Their missions stem from the May 1995 Circular, amended by the latest 2003 recommendations of the French High Council for Public Health (CSHPF): case investigations, treatment of tuberculosis and latent tuberculosis infections, targeted screening of at-risk groups, and mandatory BCG vaccination. Finally, this unit serves as a link with other department services (vaccinations, school health, maternal and child health), external partners (occupational health, associations), and institutions. Since June 2002, an active partnership has been established with the Assistance publique and, in particular, the tuberculosis referral physicians at each Parisian facility. Under an agreement with Samusocial, their mobile tuberculosis control team is responsible for the treatment and follow-up of 20 to 30 tuberculosis cases per year housed in nursing beds and receiving treatment administered under daily supervision (DOT). The aim of this article is to demonstrate how the creation of this unit, comprising two physicians and four secretaries, contributes to a better analysis of local epidemiology and the actions carried out by the SLAT, with the goal of adapting the strategy to the Parisian context. (Excerpt R.A.)