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Advanced HIV disease (AHD)—defined by a CD4 count <200 cells/mm 3—is associated with poor health outcomes. This study used household surveys from 13 countries in Sub-Saharan Africa to estimate the proportion of all people with AHD in the region. Among 28 040 surveyed people with HIV (65% female, median age 38, 53% resident in rural areas), AHD was found in nearly 10% (n=2261). AHD was associated with male sex and older age but not with rural versus urban location or economic status. Based on HIV prevalence data, nearly 2 million people were estimated to have AHD in Sub-Saharan Africa. The findings highlight the continued need for comprehensive HIV care alongside antiretroviral therapy provision in the region.