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Introduction: The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face. In this scoping review, we identify some of the barriers this high-risk group experienced during the early days of the pandemic and assess novel solutions to overcome these barriers., Methods: A scoping review was performed following PRISMA-Sc guidelines looking for studies focusing on COVID-19 testing among individuals experiencing housing insecurity. Barriers as well as solutions to barriers were identified as applicable and summarized using qualitative methods, highlighting particular ways that proved effective in facilitating access to testing access and delivery., Results: Ultimately, 42 studies were included in the scoping review, with 143 barriers grouped into four categories: lack of cultural understanding, systemic racism, and stigma; medical care cost, insurance, and logistics; immigration policies, language, and fear of deportation; and other. Out of these 42 studies, 30 of these studies also suggested solutions to address them., Conclusion: A paucity of studies have analyzed COVID-19 testing barriers among those experiencing housing insecurity, and this is even more pronounced in terms of solutions to address those barriers. Expanding resources and supporting investigators within this space is necessary to ensure equitable healthcare delivery., Competing Interests: CP was employed by the Healthspring Global Inc. CP reports receiving consulting fees from Abbott Molecular and Rapid Diagnostics. ET has been a consultant for Biomeme, Inc., has a patent pending for Methods to Diagnose and Treat Acute Respiratory Infections (US20180245154A1), and is currently employed by Danaher Corp. MC-W reports receiving support for research from the NIH (1U24-MD016258), National Institute of Allergy and Infectious Diseases (HHSN272201500006I, 1K24-AI143971), U.S. Food and Drug Administration (5U18-FD006298), and industry for drug development in adults and children. CW reports grants or contracts from DARPA, NIH-ARLG/NIAID/VTEU/NIMHO/NIGMS, Sanofi, Najit, CDC, Patient-Centered Outcomes Research Institute, USAMRAA, DOD, Abbott, and Pfizer; consulting fees from Arena Pharmaceuticals, BioFire, FHI Clinical, Giner, Karius, and SeLux Diagnostics; support for attending meetings and/or travel from American Society for Microbiology; patents planned, issued or pending for: biomarkers for the molecular classification of bacterial infection, methods to diagnose and treat acute respiratory infections, gene expression signatures useful to predict or diagnose sepsis and methods of using the same, host based molecular signatures of human infection with SARS-CoV-2 (COVID19), methods of identifying infectious disease and assays for identifying infectious disease, and nasopharyngeal protein biomarkers of acute respiratory virus infection and methods of using same; participation on a Data Safety Monitoring Board or Advisory Board for IDbyDNA, Janssen, Regeneron, Roche Molecular Sciences; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid for American Society for Microbiology and American Society of Tropical Medicine and Hygiene; and other financial or non-financial interests with Biomeme and Predigen, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Johannesson, Glover, Petti, Veldman, Tsalik, Taylor, Hendren, Neighbors, Tillekeratne, Kennedy, Harper, Kibbe, Corbie, Cohen-Wolkowiez, Woods and Lee.)

Financing options available through the private sector and government agencies can fund facility renovations or new construction. To upgrade IT, hospital leaders have three major financing options: purchase, use cloud-based services for a fee, or lease. Hospital leaders may finance physician integration like other capital projects, but there are risks to diverting dollars from buildings.

In today's uncertain economic environment, when seeking to finance a capital project, healthcare borrowers should adopt a multi-tracked funding strategy that permits them to change capital-funding routes quickly in response to changing circumstances. The multi-tracking process requires two stages prior to securing a commitment and beginning the closing process: due diligence and indication of interest. This process should present no material additional cost during these two stages, giving healthcare borrowers the flexibility to explore a variety of financing options.