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The Chulalongkorn-Hasanuddin Rifampicin-Resistant Tuberculosis Screening Tool (CUHAS-ROBUST) is an artificial intelligence–based (AI–based) application for rifampicin-resistant tuberculosis (RR-TB) screening. This study aims to elaborate on the drug-resistant TB (DR-TB) problem and the impact of CUHAS-ROBUST implementation on RR-TB screening.

A qualitative approach with content analysis was performed from September 2020 to October 2020. Medical staff from the primary care center were invited online for application trials and in-depth video call interviews. Transcripts were derived as a data source. An inductive thematic data saturation technique was conducted. Descriptive data of participants, user experience and the impact on the health service were summarized

A total of 33 participants were selected from eight major islands in Indonesia. The findings show that DR-TB is a new threat, and its diagnosis faces obstacles particularly prolonged waiting time and inevitable delayed treatment. Despite overcoming the RR-TB screening problems with fast prediction, the dubious screening performance, and the reliability of data collection for input parameters were the main concerns of CUHAS-ROBUST. Nevertheless, this application increases the confidence in decision-making, promotes medical procedure compliance, active surveillance and enhancing a low-cost screening approach.

The CUHAS-ROBUST achieved its purpose as a tool for clinical decision-making in RR-TB screening. Moreover, this study demonstrates AI roles in enhancing health-care quality and boost public health efforts against tuberculosis.

Out-of-pocket (OOP) payments continue to be a major method of financing healthcare in many low- and middle-income countries including Malaysia. Although macro-level data show that this is a substantial percentage of national health expenditure, at the grassroots level, the amount spent on health by households remains unknown in Malaysia. The purpose of this paper is to assess the validity and reliability of an adapted-for-purpose questionnaire designed to capture urban household health expenditures (HHEs) among Malaysian households.

This two-part study assessed content validity of the questionnaire using three experts and the reliability of the questionnaire through a test-retest study among 50 OOP-paying patients followed up at one private primary care clinic in Kuala Lumpur. This study was approved by the Malaysian Research Ethics Committee (NMRR-16-172-29311-IIR).

The validity of the 83-item questionnaire was high, with an item content validity index of 1.00 and a scale content validity index average score of 1.0 agreed to among the evaluating experts. In the test-retest reliability study, the majority of the categorical questionnaire items had perfect agreement values (k=0.81-1.00). Continuous questionnaire items were also found to be highly reliable with no significant differences between the test-retest segments and high correlation coefficient values (intra-class correlation coefficient>0.7).

The HHE questionnaire had excellent content validity and very high test-retest reliability. The results of this study suggest that this questionnaire could be used in Malaysian studies to determine actual urban HHE which is a first step toward developing universal health coverage for all.