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Background: Ukraine has one of the largest burdens of HIV in the European region. Over the past decade, significant strides have been made to successfully decrease the rate of HIV transmission. This analysis of HIV testing and entry into care in Western Ukraine provides data in an understudied region of Ukraine. Methods and findings: We analyzed records of HIV testing by category performed within the Lviv Oblast between 2005 and 2013. We also analyzed aggregate registration data from the Lviv Regional AIDS Center. The three highest HIV risk testing categories and their relative percent positive were 1) sexual contact with known HIV partner (20.5%) 2) current or past intravenous drug use (IDU) (13.5%) and 3) history of incarceration (11.5%). The rates of positive tests for IDU and incarcerated patients decreased over this time period. Evaluation of registration into care demonstrated that between 2005-2008, 36.6 % of positive tests resulted in registration into care compared to 54.5% between 2009- 2013. Conclusions: New HIV diagnoses have shifted from within predominantly IDU and incarcerated populations to more broad based screening categories consistent with the known shift to a generalized HIV epidemic. The overall rate of registration into care remains low. More efforts are needed to target HIV positive patients to engage them to register for care.