Introduction: HIV counseling and testing is a gateway to prevention, treatment, care and supportrnservices and an essential tool in the control of HIV/AIDS epidemic. Currently HIV status has been very rnlow which cannot be achieved only through the traditional VCT alone and another alternative, routinernHIV testing and counseling of patients, also called provider initiated HIV Counseling and testing isrnproposed.rnObjective: To assess the acceptability and associated factors of provider initiated HIV counseling andrntesting among OPD clients with possible clinical sign of HIV infection in West Arsi zone, Ethiopia. rnMethods: Facility based cross sectional study was conducted on outpatient department clients withrnpossible clinical sign of HIV infection in 6 selected health facilities in West Arsi Zone, Ethiopia. Thernhealth facilities were selected randomly; study subjects who came to the health facilities werernconsecutively interviewed. Data collected by a pre-tested, structured interview questionnaire.rnRegression model was used to assess factors associated with acceptability of provider initiated HIVrnCounseling and testing. rnResults: A total of 539 clients were interviewed with a response rate of 92.3%. The majorities (66.4%)rnwere married, major age distribution was range from 25-29 (29.1%) and the main religion was Muslimrn(66.2%). Knowledge on importance of provider initiated HIV Counseling and testing was low.rnThernwillingness and overall acceptability rate was 86.5%, and 83.1% respectively.rn The major perceivedrnbarriers for acceptability were mainly thinking self as not being at risk, followed by fear of stigma andrndiscrimination. On adjusted covariates of acceptability, acceptability of PIHCT was found to bernassociated with having information on PIHCT service (OR=0.36; CI=0.22-0.60), less and much supportrnfor PIHCT (OR=0.30; CI=0.11-0.85 and OR=0.31; CI=0.12-0.77) and tested for HIV before (OR=0.20;rnCI=0.10-0.41)rnConclusion and Recommendations: The acceptability noticed in this study is high. The majorrnperceived barriers for acceptability was thinking self as not being at risk. Having information onrnPIHCT service, tested for HIV before, and extent of support for PIHCT were found to be importantrnpredictors of acceptability of PIHCT. Hence, intensive IEC/BCC and promotional activities throughrndifferent means should be in place to raise level of awareness, support and routine testing to facilitaternits acceptability and reduce major barriers that affect PIHCT service utilization at all level.