Background In public health, traditional 4Ps (product, price, place and promotion) of the marketing mix have been successfully used to influence clients/patients to adopt desired health behaviors and health status changes in reproductive health, tuberculosis (TB), malaria, child survival and human immuno-virus (HIV) interventions. However, the use of additional 3Ps (Physical evidence, People and Process) of the marketing mix have rarely been used in public health interventions. This study examined the influence of physical evidence on voluntary counseling and testing (VCT) uptake among adolescents in Tanzania.Methods A cross-sectional study design using quantitative method was conducted in Dodoma. A multi-stage random sampling method was used to select nine secondary schools and 449 study participants. Self-administered structured questionnaire was used. Data was analyzed using SPSS v17. Relationship between independent and dependent variables was analyzed using binary logistic regression and correlation analysis with p-value of ˂ 0.5 regarded as significant. Binary logistic regression was used to determine predictors of VCT uptake. Descriptive statistics was used to analyze participants’ characteristics and ranking of physical evidence variables’ on VCT uptake among adolescents.Results Of 449 study participants, 54% and 46% were females and males respectively. The participants’ age range was 12–19 years. 96% of respondents had knowledge of VCT, 90.6% were willing to test for HIV, however; 78% had not tested for HIV. Physical evidence variable modern equipment was highly ranked influential variable regarding VCT uptake. Independent variables modern equipment, physical facility, personnel and materials were found predictors of VCT uptake. Participant characteristics age and school type were also predictors for VCT uptake.Conclusions Despite majority of adolescents had knowledge on VCT service and were willing to test for HIV, VCT uptake was low. Meaning that knowledge and willingness a lone are not enough to influence VCT uptake. Physical evidence variables modern equipment, physical facility, personnel and materials when integrated in HIVprevention strategies and interventions can increase VCT uptake among adolescents in Tanzania. Consideration of individual expectation variations and other predictor variables like age and school type need to be incorporated in designing VCT interventions.