Center for Epidemiology & Healthcare Delivery Research


Underserved and vulnerable populations are understudied,
which limits knowledge of their healthcare needs.


The JPS Center for Epidemiology & Healthcare Delivery Research (CEHDR) was established in December 2016 to understand the healthcare needs of underserved or vulnerable populations and identify approaches that optimize clinical effectiveness and reduce disparities for these populations. Our investigators use population sciences such as epidemiology, health services research, and biostatistics to address this goal. Our research focuses on the care continuum within three program areas:

  • Cancer
  • Hepatitis C
  • HIV


Collaborating Clinics



Affordable Care Act and Cancer Stage at Diagnosis
in an Underserved Population


Yan Lu, MD, MPH; Bradford E Jackson, PhD, MPH; Aaron W Gehr, MPH; Deanna Cross, PhD;
Latha Neerukonda, MD; Bhavna Tanna, MD; Bassam Ghabach, MD; Rohit P Ojha, DrPH


  • Why was this study conducted?
    • The Affordable Care Act (ACA) was intended to reduce the number of uninsured individuals, particularly among underserved populations (i.e. people with socioeconomic barriers to care), but some states such as Texas did not expand Medicaid coverage as part of ACA.
    • We wanted to understand the effect of ACA on cancer stage at diagnosis among 1) underserved cancer patients in a safety-net health system, 2) cancer patients in Tarrant County, 3) cancer patients in Texas overall.
  • What did this study find?
    • After ACA was implemented, we observed a small decrease in the proportion of uninsured cancer patients in a safety-net health system, Tarrant County, and Texas overall.
    • We did not observe earlier cancer stage at diagnosis in any of these populations (figure below).

Affordable Care Act chart

  • What do the findings mean?
    • Studies in states where Medicaid coverage was expanded are reporting earlier cancer diagnosis.
    • Medicaid expansion might be one option to help earlier cancer detection in Texas, especially for underserved individuals.




Name Title Research Area
Rohit P. Ojha, DrPH Director Cancer
Afiba Manza-A. Agovi, PhD Assistant Member HIV
Mirsada Serdarevic, PhD Assistant Member Hepatitis C/Substance Abuse



Name Title Research Area
Ifedi Anikpo, MD, MPH Epidemiologist HIV
Tzu-Chun Chu, MPH Data Analyst Hepatitis C
Kevin Craten, MHA Program Coordinator  
Matthew Cvitanovich, MPH Data Analyst HIV
Aaron Gehr, MPH Epidemiologist Cancer
Yan Lu, MD, MPH Data Analyst Cancer
Brooke R. MacDonald, MSPH Epidemiologist Hepatitis C


Affiliated Faculty

Name Primary Affiliation Research Area
Esther Fasanmi, PharmD JPS Pharmacy Clinical Services Outpatient Hepatitis C, HIV
Bassam Ghabach, MD JPS Oncology & Infusion Center Cancer
Mandeep Matta, MD JPS Healing Wings Clinic HIV
Kalyani Narra, MD JPS Oncology & Infusion Center Cancer
Rachel Stewart, DNP, MSN Acclaim Gastroenterology Hepatitis C



Name Title Research Area
Esther Annan, MD, MPH Predoctoral Fellow Hepatitis C
Jonathan Moore, MPH Predoctoral Fellow Hepatitis C
Nasrin Sultana, MD Research Intern HIV