Voluntary HIV counseling and testing (VCT) is one of the priority interventions in HIV/AIDS prevention, care and support. VCT is an entry point for the prevention of HIV transmission from mother to child and accessing VCT benefit from PMTCT services. This study was designed, to assess the magnitude and identify factors associated with pregnant women’s expressed willingness towards VCT and describe their knowledge. Cross-sectional institution based interview survey of 421 pregnant women was held in one district hospital, two health centers and three health stations. The study was complimented with four FGD and Key-informant interviews. The study was done in Wukro & Kleteawlaelo Woredas of Tigray Regional State, north Ethiopia. The expressed willingness of study participants for VCT was found to be 74.1%. On examination of multiple factors to detect whether there is association with willingness to VCT or not: being multigravida (AOR=7.1, 95%CI=1.05,48.3),intention to discuss HIV positive result with partner(AOR=7.01, 95% CI=1.74,28.15), believing partner has a greater role for VCT(AOR=3.84, 95%CI=1.12,13.23)were found to have an association .The level of awareness on VCT and PMTCT was 80.3 and 88.5% respectively. This study revealed high-level of awareness about HIV, with as well marked misconception. Expressed willingness was lower when compared to other studies and it was influenced mainly by gravidity of the woman and male partners. Male partner involvement and coordinated IEC can assist to overcome barriers of willingness to VCT. This study could contribute for VCT and PMTCT program expansion in the study area and elsewhere with similar characteristics