Background: HIV Counseling and Testing is one of the effective means for prevention of the spread of HIV infection. Partners and family members of PLHIVs are at higher risk for HIV infection. Thus, studying the acceptance of index case HTC and disclosure is important to improve the service. Objectives: This study aims to identify barriers to disclose HIV status by index clients and factors predict the acceptance of ICHTC. Methods: A cross-sectional study was conducted in Zewditu Memorial hospital and OSSA care and support outlet. A facility based systematic random sampling was followed to select 452 HIV positive individuals. Descriptive and inferential stastics wre usedto assess factors associated with acceptance of index case HTC and disclosure of HIV sero status. Result፡ The level of disclosure to main sexual partner was 56%. PLHIVs who had no sexual partner than spouse [OR: 8.15; 95% CI, 2.06-32.19] and had positive attitude to index case HTC [OR: 2.55; 95% CI, 1.63-4.0] were more likely to disclose their status. Index clients whose family and partner accepted HTC were 64% and 73%, respectively. Disclosure of status to family [OR: 2.40; 95% CI, 1.54-3.74] and friends [OR: 2.06; 95% CI, 1.19-3.57], being knowledgable [OR: 2.19; 95% CI, 1.39-3.44] and non-regular partnership [OR: 3.86; 95% CI, 1.68-8.83] were positively associated with acceptance of ICHTC. Nondisclosure to main sexual partner was protective to acceptance HTC. Conclusion and recommendation: Disclosure of self status, positive attitude to HTC, initiation for testng and being knowledgeable were factors influenced acceptance of HTC. Poor knowledge on HIV and risk assessment and negative attitude to ICHTC were barriers to disclosure. Intervention should prioritize mutual disclosure of HIV status, make clear understanding on HIV and its risks, benefits of ICHTC and develop positive attitude to ICHTC.