Cited literature: (1) Sullivan, L.M., Massaro, J.M. and D'AgosƟno, R.B., Sr. (2004). PresentaƟon of mulƟvariate data for clinical use: The Framingham Study risk score funcƟons. StaƟst. Med., 23: 1631-1660. (2) World Health Organizaton (2015). Guidelines for the prevenƟon, care and treatment of persons with chronic hepaƟƟs B infecƟon. ISBN: 978-92-4-154905-9. (3) Shimakawa, Y. et al. (2018). Development of a simple score based on HBeAg and ALT for selecƟng paƟents for HBV treatment in Africa. J. Hepatol. 69, 776–784. AﬃliaƟons: (1) Insitut Pasteur, Paris, France, (2) Vesƞold Hospital, Tønsberg, Norway, (3) University of Oslo, Oslo, Norway, (4) Bogodogo University Hospital Center, Ouagadougou, Burkina Faso, (5) University of Bern, Bern, Switzerland, (6) University of Zambia, Lusaka, Zambia, (7) University of Alabama at Birmingham, Birmingham, United States, (8) Tygerberg Hospital and Stellenbosch University, Stellenbosch, South Africa, (9) InsƟtute of InfecƟon, Veterinary and Ecological Sciences, Liverpool, United Kingdom, (10) Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, (11) University of Cape Town, Cape Town, South Africa, (12) Yalgado Ouédraogo University Hospital Center, Ouagadougou, Burkina Faso, (13) Centre Regional de Recherche et de FormaƟon, Centre Hospitalier NaƟonal Universitaire de Fann, Dakar, Senegal, (14) Liverpool School of Tropical Medicine, Liverpool, United Kingdom, (15) Faculty of Medical Sciences, University of Jos, Jos, Nigeria, (16) Imperial College London, London, United Kingdom, (17) London School of Hygiene & Tropical Medicine, Banjul, Gambia, (18) University of Oxford, Oxford, United Kingdom, (19) The Francis Crick InsƟtute, London, United Kingdom, (20) University College, London Hospitals, London, United Kingdom, (21) Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa, (22) St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, (23) Hopital Principal de Dakar, Dakar, Senegal. In sub-Saharan Africa, clinical reference standard to assess eligibility for treatment (HBV DNA PCR, transient elastography, liver biopsy) is oŌen restricted to naƟonal-level centers. To improve uptake of anƟ-HBV therapy, we need either signiﬁcant investment to make viral load tesƟng available even at peripheral health faciliƟes, or the development of simpliﬁed eligiblity criteria. Here, we found that a combinaƟon of platelet counts, AST and ALT levels - tests available even at low level health faciliƟes - can idenƟfy the majority of HBV-infected people in need of AVT. Our results suggest that even in the absence of upgrades in laboratory and radiology, decentralizaƟon of clinical staging for HBV-infected people may be realized in SSA. Conclusion Performance of diﬀerent guidelines and scoring systems, in the validation dataset. Because it relies on biopsy or liver sƟﬀness measurments, clinical reference standard (EASL 2017 guidelines) are only available in TIER4 level faciliƟes. Two eligibility evaluaƟon tools have already been proposed in the past years. WHO 2015 guidelines relies notably on viral load (VL) and are available at TIER3 level faciliƟes (or above). They fall short of detecting half of eligible persons (38% sensitivity), but keep high speciﬁcity (98%), leading to an overall AUROC of 0·68 [0·64–0·72]. TREAT-B scoring system requires HBeAg testing, and is thus available at TIER3 level facilities. It achieves 0·87 [0·84–0·90] AUROC, with 88% sensitivity and 86% speciﬁcity. Our simple scoring system, available in TIER2, achieves comparable results, with 0·83 [0·79–0·86] AUROC, 79% speciﬁcity, and 87% sensitivity in the validation dataset. However, it only relies on platelet and transaminases, and is thus available at TIER2 level faciltities Test n AUROC Se (%) Sp (%) TP FN FP TN HEPSANET scoring system 1452 0·83 [0·79, 0·86] 79 87 117 31 174 1130 WHO 2015 guidelines 1439 0·68 [0·64, 0·72] 38 56 98 92 28 1276 TREAT-B 1439 0·87 [0·84,