Background: Voluntary counselling and testing has always been one of the HIV prevention and treatment techniques. Its awareness and knowledge have been well documented in most studies. High level HIV/AIDS related awareness and knowledge as well as that of VCT have not been translated into optimum utilization of VCT especially in HIV highly prevalent regions. However, this study examined the associated factors that correlate with VCT uptake among sexually active adults in Taraba State, one of Nigeria’s HIV most prevalent states. Method: The study consists of participants randomly drawn from five local government areas of Taraba State. Four hundred questionnaires were administered to obtain responses on level of VCT utilization, HIV-related awareness and knowledge, VCT-related awareness and knowledge, as well as other associated factors. Uptake of VCT was considered as the outcome variable with dichotomous response. Relationships between demographic characteristics and baseline factors against the outcome variable were cross-tabulated using Chi-square. Also, a multiple logistic regression analysis was performed to determine associated factors which have significant effects on VCT uptake. Results: Our findings showed a very low VCT utilization level (40.9%) relative to the awareness level (97.7%). Results also showed that all the six factors considered in the study except one are statistically associated with VCT uptake at 0.05 level of significance. Conclusion: It is concluded that high level of awareness does not transcend to high utilization of VCT in the region, and effort must be intensified to improve update of HCT in the grossly affected areas.