HIV post-exposure prophylaxis (PEP) and PEP-in-pocket (PIP) for women: A rodgers' evolutionary concept analysis

BackgroundHIV prevalence among cis and trans women is increasing, yet prevention medication uptake remains low. Despite extensive literature regarding pre-exposure prophylaxis (PrEP), less is known about post-exposure interventions for women. Among women, non-occupational post-exposure prophylaxis (PEP) is mainly used in sexual assault centres and rarely otherwise. PEP-in-Pocket (PIP) is a self-initiated PEP option for infrequent high-risk exposures (<4/year) and could offer women more agency over their sexual health. PIP, an evolution of PEP endorsed by international guidelines, may better address women's diverse needs, yet remains understudied and underutilized.ObjectiveTo develop a clear contextual understanding of PEP and PIP in the context of women based on its current use in the literature.DesignRodgers' Evolutionary Concept Analysis. Rodger's methodology is a flexible, non-linear approach suited for evolving health concepts and involves three phases: conceptualizing the concept; identifying key attributes, antecedents, and consequences; and interpreting findings to inform future research.Data sourcesScholarly peer-reviewed literature.MethodsA systematic search (January 2012-May 2025) across Medline, Emcare, and Global Health identified 33 relevant studies. Two reviewers screened and extracted texts using Covidence. Rodgers' evolutionary concept analysis was used to examine PEP and PIP among cis and trans women.ResultsPEP attributes include reactive use after exposure, clinical initiation, and time-sensitive access. Key attributes of PIP include self-initiation, episodic use, autonomy, and accessibility outside healthcare settings. Shared antecedents include barriers to access, and the need for alternative HIV prevention strategies. PIP-specific antecedents include infrequent high-risk exposures and a desire for greater individual control, especially among those who may not interact with healthcare providers. Consequences of both strategies include reduced HIV risk and expanded options. Overall, the literature on PIP was limited, but increased agency, empowerment, and potential to fill HIV prevention gaps were noted.ConclusionsPEP and PIP are promising, women-centered HIV prevention strategies that support autonomy and timely care but remain underutilized. This analysis identifies significant gaps in research and implementation for women, underscoring the need for further investigation to advance equitable HIV prevention.