The aim of this study was to assess the impact of a revolving loan fund
(RLF) on timing of device insertion and long-acting reversible contraception
) access among a high-risk urban population at 3 Boston community health centers
Three health centers were identified to implement a RLF. Each clinic received $5000 from the RLF to purchase LARC
devices. Data collected through medical record review retrospectively 1 year prior to start of the RLF and prospectively for 1 year thereafter included patient demographics, type of LARC
selected, patient's date of documented interest in a LARC
device, and date of insertion. The effect of a RLF on delay to LARC
insertion was tested using negative binomial regression, controlling for site and potential confounding variables between the pre- and post-RLF periods.
Three urban community health centers
Reproductive-aged women who received family planning services at the 3 participating health centers.
Main Outcome Measures:
Increasing access to LARC
and decreasing wait times to LARC
insertion after implementation of the RLF.
Data on 133 patients in the pre-RLF group and 205 in the post-RLF group were collected. There were no statistically significant differences in demographic or clinical characteristics between the 2 time periods. LARC
uptake increased significantly from the pre- to post-RLF period, specifically among implant users. There was a statistically significant decrease in the mean number of days in delay from interest to insertion from the pre- to post-RLF period (pre-RLF: 31.3 ± 50.6 days; post-RLF: 13.6 ± 16.7 days, adjusted P
< .001). The reasons for the delay did not differ significantly between the 2 time periods.
The RLF decreased wait time for the devices and increased overall insertion rates. This may serve as a promising solution to improve LARC
access in community health centers
. This project could be expanded to include more health centers, creating a city wide RLF. This expansion could allow for further data analysis, including unintended pregnancy rates with LARC
continuation rates, and sustainability of a RLF.