NMA HCV Specialist HOTMA Now Actual Exam Questions and
Answers
Already Graded A+ Latest Versions 2026
HCV Specialist & Housing Integration Comprehensive Practice Review - 50 Questions | 2026/2027 Aligned
Aligned with CDC HCV Testing/Treatment Guidelines, SAMHSA Integrated Care Models, HUD HOTMA
Regulatory Standards, NMA Certification Competencies
Section Questions
Section 1: HCV Fundamentals: Epidemiology, Transmission, Screening & Diagnostic Algorithms Q1-Q10
Section 2: Treatment Protocols, DAA Regimens & Patient Monitoring Q11-Q20
Section 3: HOTMA Compliance, Housing Assistance Integration & Social Determinants of Health Q21-Q30
Section 4: Patient Navigation, Care Coordination & Interprofessional Collaboration Q31-Q40
Section 5: Ethics, Cultural Humility, Documentation & Professional Practice Standards Q41-Q50
Section 1: HCV Fundamentals: Epidemiology, Transmission, Screening &
Diagnostic Algorithms (Q1-Q10)
Q1: A 45-year-old patient with a history of injection drug use presents to a community health center
for routine care. Per the 2026 CDC HCV screening recommendations, which of the following is the
MOST appropriate initial screening test?
A. Quantitative HCV RNA PCR
B. Hepatitis C antibody (anti-HCV) screening test
C. HCV genotype assay
D. HCV core antigen test
Correct Answer: B
Rationale: The 2026 CDC guidelines recommend universal HCV screening with an anti-HCV antibody test as the
initial step for all adults aged 18-79 and all pregnant persons during each pregnancy. Anti-HCV Ab is the
recommended first-line screening test; if reactive, it should be followed by an HCV RNA test to confirm current
infection. Quantitative HCV RNA (A) is a confirmatory test, not a screening test. Genotype testing (C) is performed
after confirming active viremia. HCV core antigen (D) is an alternative confirmatory test but not the initial screening
method.
Q2: A pregnant patient at 28 weeks gestation tests anti-HCV positive but HCV RNA negative. Which
of the following statements is MOST accurate regarding her HCV status and management?
A. She has active HCV infection and requires immediate DAA treatment to prevent perinatal transmission.
B. She has resolved HCV infection (either spontaneous clearance or prior successful treatment) and does not
require antiviral therapy at this time.
C. She has a false-positive antibody result and should be retested in six months.
D. She has an indeterminate result and requires a liver biopsy for definitive diagnosis.
Correct Answer: B
Rationale: A reactive anti-HCV antibody with a negative HCV RNA indicates resolved HCV infection, either through
spontaneous clearance or prior successful antiviral treatment. The patient does not have active infection and does not
, require current antiviral therapy. Perinatal transmission risk from women with resolved HCV is negligible. Immediate
DAA treatment during pregnancy (A) is not indicated without confirmed viremia. The result is not false-positive (C)
since antibody positivity is confirmed by negative RNA, indicating resolved infection. Liver biopsy (D) is not required
for this diagnosis.
Q3: Which of the following groups has the HIGHEST prevalence of chronic HCV infection in the
United States according to 2026 epidemiological data?
A. Healthcare workers with occupational needlestick exposure
B. Persons born between 1945 and 1965 (baby boomer cohort)
C. Persons who currently inject drugs (PWID)
D. Persons with multiple sexual partners
Correct Answer: C
Rationale: While the 1945-1965 birth cohort historically had the highest HCV prevalence, the 2026 CDC data
indicates that persons who currently inject drugs (PWID) have the highest prevalence of chronic HCV infection, with
estimates exceeding 50% in this population. This reflects ongoing transmission through needle/syringe sharing. Baby
boomers (B) still carry a significant burden due to historically unscreened blood products and medical procedures, but
PWID prevalence now exceeds this cohort. Healthcare workers (A) and persons with multiple sexual partners (D)
have substantially lower prevalence rates.
Q4: A patient's anti-HCV antibody test is reactive. The HCV RNA PCR result is positive at 2.3 million
IU/mL. Which fibrosis assessment tool would be MOST appropriate as an initial non-invasive
evaluation of liver fibrosis staging?
A. Complete blood count with differential
B. FIB-4 index calculation using age, AST, ALT, and platelet count
C. Hepatic venous pressure gradient measurement
D. Iron studies and ferritin level
Correct Answer: B
Rationale: The FIB-4 index is the recommended initial non-invasive fibrosis assessment tool for patients with
confirmed chronic HCV. It uses routinely available laboratory values (age, AST, ALT, platelet count) to estimate the
degree of liver fibrosis and helps determine urgency of treatment. It is cost-effective, widely accessible, and has good
predictive accuracy for significant fibrosis (F2-F4). Hepatic venous pressure gradient (C) is an invasive procedure
reserved for advanced cirrhosis evaluation. CBC alone (A) and iron studies (D) do not provide fibrosis staging
information.
Q5: A 32-year-old woman recently tattooed at an unlicensed facility presents concerned about HCV
exposure. She reports no history of injection drug use or blood transfusions. Which statement
regarding HCV transmission is MOST accurate?
A. HCV is primarily transmitted through casual household contact and shared eating utensils.
B. Tattooing at unlicensed facilities is a recognized risk factor for HCV transmission due to potential
contaminated equipment.
C. Sexual transmission of HCV is the most common route of infection among heterosexual couples.
D. HCV cannot be transmitted through percutaneous exposure; only mucosal contact poses risk.
Correct Answer: B
Rationale: Tattooing and body piercing at unregulated or unlicensed facilities are recognized risk factors for HCV
transmission, as contaminated needles, ink, or equipment may be reused without proper sterilization. HCV is
transmitted primarily through bloodborne routes, not casual contact (A). Sexual transmission risk is low in
heterosexual monogamous couples (approximately 0-0.6% per year) and is not the most common route (C).
Percutaneous exposure is the primary transmission route, contradicting (D). The CDC identifies injection drug use,
, blood transfusions before 1992, and unregulated tattooing/piercing as key risk factors.
Q6: A patient with confirmed chronic HCV infection has an APRI score of 1.8 and a FIB-4 score of
3.2. These results MOST strongly suggest which of the following?
A. No significant fibrosis (F0-F1), indicating monitoring without immediate treatment.
B. Significant fibrosis or possible cirrhosis (F3-F4), warranting expedited treatment initiation.
C. Acute HCV infection that will likely resolve spontaneously.
D. Hepatocellular carcinoma requiring immediate oncologic referral.
Correct Answer: B
Rationale: An APRI score greater than 1.0 (here 1.8) and a FIB-4 score greater than 2.67 (here 3.2) both indicate
significant fibrosis (F3) or cirrhosis (F4). These patients require expedited DAA treatment initiation due to the risk of
progressive liver disease, decompensation, and hepatocellular carcinoma. Non-invasive scoring with APRI and FIB-4
above threshold values warrants further evaluation (possibly transient elastography) and urgent treatment. No
significant fibrosis (A) would present with scores well below these thresholds. The results do not suggest acute
infection (C). While HCC risk is elevated, these scores alone do not diagnose HCC (D) and do not replace imaging
surveillance.
Q7: According to the 2026 CDC HCV testing algorithm, which of the following is the CORRECT
sequence for HCV diagnostic testing?
A. HCV RNA PCR first; if positive, confirm with anti-HCV antibody test.
B. Anti-HCV antibody test first; if reactive, follow with HCV RNA PCR for confirmatory testing.
C. HCV genotype first; if detectable, proceed with HCV RNA PCR and antibody testing.
D. Liver biopsy first; if fibrosis is identified, order anti-HCV antibody and HCV RNA simultaneously.
Correct Answer: B
Rationale: The 2026 CDC-recommended HCV testing algorithm begins with an anti-HCV antibody test for initial
screening. If the antibody test is reactive, it is followed by a quantitative HCV RNA PCR to distinguish between active
infection (positive RNA) and resolved infection (negative RNA). The reverse sequence (A) is incorrect because RNA
testing is more expensive and not appropriate as a first-line screening tool. Genotype testing (C) is performed after
confirming active viremia. Liver biopsy (D) is not part of the diagnostic algorithm for HCV screening or confirmation.
Q8: A public health clinic is implementing an HCV screening program for individuals experiencing
homelessness. Which risk factor identified during intake assessment would MOST warrant
prioritized HCV screening according to CDC guidelines?
A. Current or history of injection drug use
B. History of ear piercing at a commercial establishment
C. Regular consumption of well water in rural areas
D. Employment in the food service industry
Correct Answer: A
Rationale: Current or history of injection drug use is the strongest risk factor for HCV infection and warrants
prioritized screening. The CDC recommends universal screening for all adults, but among persons experiencing
homelessness, PWID have the highest prevalence and should be prioritized for immediate linkage to testing and
treatment. Ear piercing at a commercial establishment (B) with sterile equipment carries negligible risk. Well water
consumption (C) and food service employment (D) are not recognized HCV transmission risk factors.
Q9: A 28-year-old patient who recently started injection drug use within the past three months
presents to an urgent care clinic with fatigue and jaundice. ALT is elevated at 450 U/L. Anti-HCV
antibody is positive and HCV RNA is detected at 8.2 million IU/mL. This presentation is MOST
Answers
Already Graded A+ Latest Versions 2026
HCV Specialist & Housing Integration Comprehensive Practice Review - 50 Questions | 2026/2027 Aligned
Aligned with CDC HCV Testing/Treatment Guidelines, SAMHSA Integrated Care Models, HUD HOTMA
Regulatory Standards, NMA Certification Competencies
Section Questions
Section 1: HCV Fundamentals: Epidemiology, Transmission, Screening & Diagnostic Algorithms Q1-Q10
Section 2: Treatment Protocols, DAA Regimens & Patient Monitoring Q11-Q20
Section 3: HOTMA Compliance, Housing Assistance Integration & Social Determinants of Health Q21-Q30
Section 4: Patient Navigation, Care Coordination & Interprofessional Collaboration Q31-Q40
Section 5: Ethics, Cultural Humility, Documentation & Professional Practice Standards Q41-Q50
Section 1: HCV Fundamentals: Epidemiology, Transmission, Screening &
Diagnostic Algorithms (Q1-Q10)
Q1: A 45-year-old patient with a history of injection drug use presents to a community health center
for routine care. Per the 2026 CDC HCV screening recommendations, which of the following is the
MOST appropriate initial screening test?
A. Quantitative HCV RNA PCR
B. Hepatitis C antibody (anti-HCV) screening test
C. HCV genotype assay
D. HCV core antigen test
Correct Answer: B
Rationale: The 2026 CDC guidelines recommend universal HCV screening with an anti-HCV antibody test as the
initial step for all adults aged 18-79 and all pregnant persons during each pregnancy. Anti-HCV Ab is the
recommended first-line screening test; if reactive, it should be followed by an HCV RNA test to confirm current
infection. Quantitative HCV RNA (A) is a confirmatory test, not a screening test. Genotype testing (C) is performed
after confirming active viremia. HCV core antigen (D) is an alternative confirmatory test but not the initial screening
method.
Q2: A pregnant patient at 28 weeks gestation tests anti-HCV positive but HCV RNA negative. Which
of the following statements is MOST accurate regarding her HCV status and management?
A. She has active HCV infection and requires immediate DAA treatment to prevent perinatal transmission.
B. She has resolved HCV infection (either spontaneous clearance or prior successful treatment) and does not
require antiviral therapy at this time.
C. She has a false-positive antibody result and should be retested in six months.
D. She has an indeterminate result and requires a liver biopsy for definitive diagnosis.
Correct Answer: B
Rationale: A reactive anti-HCV antibody with a negative HCV RNA indicates resolved HCV infection, either through
spontaneous clearance or prior successful antiviral treatment. The patient does not have active infection and does not
, require current antiviral therapy. Perinatal transmission risk from women with resolved HCV is negligible. Immediate
DAA treatment during pregnancy (A) is not indicated without confirmed viremia. The result is not false-positive (C)
since antibody positivity is confirmed by negative RNA, indicating resolved infection. Liver biopsy (D) is not required
for this diagnosis.
Q3: Which of the following groups has the HIGHEST prevalence of chronic HCV infection in the
United States according to 2026 epidemiological data?
A. Healthcare workers with occupational needlestick exposure
B. Persons born between 1945 and 1965 (baby boomer cohort)
C. Persons who currently inject drugs (PWID)
D. Persons with multiple sexual partners
Correct Answer: C
Rationale: While the 1945-1965 birth cohort historically had the highest HCV prevalence, the 2026 CDC data
indicates that persons who currently inject drugs (PWID) have the highest prevalence of chronic HCV infection, with
estimates exceeding 50% in this population. This reflects ongoing transmission through needle/syringe sharing. Baby
boomers (B) still carry a significant burden due to historically unscreened blood products and medical procedures, but
PWID prevalence now exceeds this cohort. Healthcare workers (A) and persons with multiple sexual partners (D)
have substantially lower prevalence rates.
Q4: A patient's anti-HCV antibody test is reactive. The HCV RNA PCR result is positive at 2.3 million
IU/mL. Which fibrosis assessment tool would be MOST appropriate as an initial non-invasive
evaluation of liver fibrosis staging?
A. Complete blood count with differential
B. FIB-4 index calculation using age, AST, ALT, and platelet count
C. Hepatic venous pressure gradient measurement
D. Iron studies and ferritin level
Correct Answer: B
Rationale: The FIB-4 index is the recommended initial non-invasive fibrosis assessment tool for patients with
confirmed chronic HCV. It uses routinely available laboratory values (age, AST, ALT, platelet count) to estimate the
degree of liver fibrosis and helps determine urgency of treatment. It is cost-effective, widely accessible, and has good
predictive accuracy for significant fibrosis (F2-F4). Hepatic venous pressure gradient (C) is an invasive procedure
reserved for advanced cirrhosis evaluation. CBC alone (A) and iron studies (D) do not provide fibrosis staging
information.
Q5: A 32-year-old woman recently tattooed at an unlicensed facility presents concerned about HCV
exposure. She reports no history of injection drug use or blood transfusions. Which statement
regarding HCV transmission is MOST accurate?
A. HCV is primarily transmitted through casual household contact and shared eating utensils.
B. Tattooing at unlicensed facilities is a recognized risk factor for HCV transmission due to potential
contaminated equipment.
C. Sexual transmission of HCV is the most common route of infection among heterosexual couples.
D. HCV cannot be transmitted through percutaneous exposure; only mucosal contact poses risk.
Correct Answer: B
Rationale: Tattooing and body piercing at unregulated or unlicensed facilities are recognized risk factors for HCV
transmission, as contaminated needles, ink, or equipment may be reused without proper sterilization. HCV is
transmitted primarily through bloodborne routes, not casual contact (A). Sexual transmission risk is low in
heterosexual monogamous couples (approximately 0-0.6% per year) and is not the most common route (C).
Percutaneous exposure is the primary transmission route, contradicting (D). The CDC identifies injection drug use,
, blood transfusions before 1992, and unregulated tattooing/piercing as key risk factors.
Q6: A patient with confirmed chronic HCV infection has an APRI score of 1.8 and a FIB-4 score of
3.2. These results MOST strongly suggest which of the following?
A. No significant fibrosis (F0-F1), indicating monitoring without immediate treatment.
B. Significant fibrosis or possible cirrhosis (F3-F4), warranting expedited treatment initiation.
C. Acute HCV infection that will likely resolve spontaneously.
D. Hepatocellular carcinoma requiring immediate oncologic referral.
Correct Answer: B
Rationale: An APRI score greater than 1.0 (here 1.8) and a FIB-4 score greater than 2.67 (here 3.2) both indicate
significant fibrosis (F3) or cirrhosis (F4). These patients require expedited DAA treatment initiation due to the risk of
progressive liver disease, decompensation, and hepatocellular carcinoma. Non-invasive scoring with APRI and FIB-4
above threshold values warrants further evaluation (possibly transient elastography) and urgent treatment. No
significant fibrosis (A) would present with scores well below these thresholds. The results do not suggest acute
infection (C). While HCC risk is elevated, these scores alone do not diagnose HCC (D) and do not replace imaging
surveillance.
Q7: According to the 2026 CDC HCV testing algorithm, which of the following is the CORRECT
sequence for HCV diagnostic testing?
A. HCV RNA PCR first; if positive, confirm with anti-HCV antibody test.
B. Anti-HCV antibody test first; if reactive, follow with HCV RNA PCR for confirmatory testing.
C. HCV genotype first; if detectable, proceed with HCV RNA PCR and antibody testing.
D. Liver biopsy first; if fibrosis is identified, order anti-HCV antibody and HCV RNA simultaneously.
Correct Answer: B
Rationale: The 2026 CDC-recommended HCV testing algorithm begins with an anti-HCV antibody test for initial
screening. If the antibody test is reactive, it is followed by a quantitative HCV RNA PCR to distinguish between active
infection (positive RNA) and resolved infection (negative RNA). The reverse sequence (A) is incorrect because RNA
testing is more expensive and not appropriate as a first-line screening tool. Genotype testing (C) is performed after
confirming active viremia. Liver biopsy (D) is not part of the diagnostic algorithm for HCV screening or confirmation.
Q8: A public health clinic is implementing an HCV screening program for individuals experiencing
homelessness. Which risk factor identified during intake assessment would MOST warrant
prioritized HCV screening according to CDC guidelines?
A. Current or history of injection drug use
B. History of ear piercing at a commercial establishment
C. Regular consumption of well water in rural areas
D. Employment in the food service industry
Correct Answer: A
Rationale: Current or history of injection drug use is the strongest risk factor for HCV infection and warrants
prioritized screening. The CDC recommends universal screening for all adults, but among persons experiencing
homelessness, PWID have the highest prevalence and should be prioritized for immediate linkage to testing and
treatment. Ear piercing at a commercial establishment (B) with sterile equipment carries negligible risk. Well water
consumption (C) and food service employment (D) are not recognized HCV transmission risk factors.
Q9: A 28-year-old patient who recently started injection drug use within the past three months
presents to an urgent care clinic with fatigue and jaundice. ALT is elevated at 450 U/L. Anti-HCV
antibody is positive and HCV RNA is detected at 8.2 million IU/mL. This presentation is MOST
