While three-dimensional Dirac semimetals have been extensively studied in centrosymmetric materials such as and , the recent colloidal synthesis of wurtzite HgTe (wz-HgTe) opens new opportunities for exploring topological quantum phases in noncentrosymmetric systems. Building on recent evidence that bulk wz-HgTe is a noncentrosymmetric Dirac semimetal, we investigate how strain and quantum confinement reshape its topology. To this end, we combine ab initio density-functional theory, semiempirical tight-binding, and approaches. Bulk wz-HgTe hosts two Dirac points along the line, i.e., along the axis, located only 37 meV above the Fermi level, indicating that the Dirac regime should be experimentally accessible by doping or electrostatic gating. We show that biaxial strain drives a sequence of topological phase transitions from a Dirac semimetal to a three-dimensional topological insulator and eventually to a multiband metal. In (0001) thin films, quantum confinement induces oscillatory transitions between trivial and topological insulating phases. We demonstrate that this behavior is governed not only by the underlying band inversion, but also by the crystal-field splitting specific to the wurtzite structure and by the presence of bulk Dirac points. In contrast, films exhibit a single topological transition and, above a critical thickness, develop surface states forming Fermi-arc-like contours that connect the projections of the Dirac points in the two-dimensional Brillouin zone. In the same weak-confinement regime, semimetallic nanowires oriented along the axis are predicted to host localized edge states that should be accessible to transport measurements or scanning tunneling spectroscopy. These results establish the topological phase diagram of wz-HgTe beyond the strong-confinement regime explored so far and reveal how crystal symmetry, inversion breaking, strain, and confinement combine to reshape the topology of a Dirac material. More broadly, they identify wurtzite HgTe as a promising platform for engineering topological phases in experimentally relevant nanostructures.