Revolving Loan Fund: A Novel Approach to Increasing Access to Long-Acting Reversible Contraception Methods in Community Health Centers

Objective: 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 (LARC) access among a high-risk urban population at 3 Boston community health centers. Design: 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 reviewretrospectively 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. Setting: Three urban community health centers. Participants: 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. Results: 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. Conclusion: 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 delay, LARC continuation rates, and sustainability of a RLF.