Background: About half of human immunodeficiency virus (HIV) infected children in Africa die before their second birthday if not treated. Majority of the HIV infected children who die have never been diagnosed as HIV infected or present too late to the health care facility, with advanced disease. To avert this, interventions to ensure early diagnosis of HIV infection in children will need to be expanded. Aims and Objectives: The present study was aimed at high lightening the usefulness of provider initiated testing and counseling of HIV in determining the prevalence of HIV exposure/infection among children (aged 0 -18 years) who attended the children out -patient clinic of Federal Medical Center Abakaliki (now Federal Teaching Hospital Abakaliki,). Materials and Methods: It is a retrospective study involved all the children that presented at the children out -patient clinic from March 2010 to February 2013, regardless of their presenting complaints and were referred for HIV antibody testing using the opt -out (provider initiated HIV testing and counseling [PITC]) model. The rapid tests were used to test for HIV. Results: A total of 13,652 children were tested within the 3 -year period, out of which 279 (2%) tested positive for HIV. Among those who tested positive to rapid test, 147 (52.7%) were males and 132 (47.3%) were females. Children <18 months of age understandably (included exposed and infected), had the highest prevalence rate 1.4% (193) while children >18 months (infected) had a prevalence rate 0.6% (86). There was statistically significant association between age and prevalence of HIV in the children (P < 0.001). Conclusion: Findings from this research suggested that PITC could be used to identify many previously undiagnosed HIV infected children, many of whom maybe asymptomatic and are at high risk of mortality.