Background: HIV rapid testing services must ensure that appropriate quality assurance programs and wellrnunderstood testing algorithms are implemeted to obtain accurate and reliable test results. Proficiency testingrnprograms are important for improving HIV rapid testing quality while conducting an onsite evaluationrnprovides a chance to observe the overall testing situation and support on identified gaps. rnObjective:To assess the performance of HIV Rapid testing sites in Rapid Test Quality ImprovementrnInitiative(RTQII) enrolled health facilities through proficiency testing and onsite evaluation. rnMethod:Health facility based cross sectional study was conducted from August to December 2019on 159rnHIV testing sites (HTS) in 41 Health facilities (HFs) in five administrative regions and two cityrnadministrations in Ethiopia. Characterized HIV dried tube specimen (DTS) PT panels were prepared andrnverified at the Ethiopian Public Health Institute (EPHI) and distributed to the sites. Also onsite evaluation,rnaccompanied by checklists with structured interviews, was conducted. The collected data was analyzed byrnSPSS version 23 and chi square test was applied to identify the association between acceptable performancernand different factors.Testing sites whose PT scores matched 100% with the expected result together withrnadherence to the National HIV Testing Algorithm(NHTA) were considered acceptable. rnResults: The overall acceptable performance (100% PT score with the correct algorithm followed) wasrnfound to be 62% while 12% scored 80% and 11% scored between 20 to 60%. The rest 15 % were notrnconsidered as acceptable due to failure to adhere to the NHTA.Testing sites that participated in ExternalrnQuality Assessment/Proficiency Testing(EQA/PT) schemes has shown better performance than those thatrndid not participate in PT schemes with 70% and 56% performance, respectively (p=0.057). Thoughrnadherence to the NHTA, Training on HIV rapid testing, following SOP, were all positively associated withrnHIV rapid testing performances, all of them were not statistically significant. rnConclusion:Expansion of HIV diagnostic services at different points of care must ensure that appropriaternquality assurance programs has been put in place. The lower level of PT performance together with problemsrnobserved during onsite evaluations calls for regular supervision, strong EQA programmes, adequate handsrnon training, and proper assignment of testing personnel.