malawi_hiv_program_reports 1.0.1 → 1.0.2

data/app/services/malawi_hiv_program_reports/clinic/patients_on_antiretrovirals.rb

@@ -0,0 +1,44 @@
+# frozen_string_literal: true
+
+# Retrieve all patients who are taking ARVs in a given time period.
+module MalawiHivProgramReports
+  module Clinic
+    class PatientsOnAntiretrovirals
+      attr_reader :start_date, :end_date
+
+      def initialize(start_date:, end_date:, **_kwargs)
+        @start_date = start_date
+        @end_date = end_date
+      end
+
+      def self.within(start_date, end_date)
+        PatientsOnAntiretrovirals.new(start_date:, end_date:)
+                                 .patients
+      end
+
+      def find_report
+        patients
+      end
+
+      def patients
+        ::DrugOrder.select('orders.patient_id AS patient_id')
+                   .joins(:order)
+                   .merge(art_orders)
+                   .where(drug_inventory_id: ArtService::RegimenEngine.arv_drugs,
+                          quantity: 1..Float::INFINITY)
+                   .where('start_date BETWEEN :start_date AND :end_date
+                         OR auto_expire_date BETWEEN :start_date AND :end_date
+                         OR (start_date <= :start_date AND auto_expire_date >= :end_date)',
+                          start_date:, end_date:)
+                   .group('orders.patient_id')
+      end
+
+      private
+
+      def art_orders
+        ::Order.joins(:encounter)
+               .where('encounter.program_id = ?', ::ArtService::Constants::PROGRAM_ID)
+      end
+    end
+  end
+end

data/app/services/malawi_hiv_program_reports/clinic/patients_on_dtg.rb

@@ -0,0 +1,36 @@
+# frozen_string_literal: true
+
+module MalawiHivProgramReports
+  module Clinic
+    class PatientsOnDtg
+      attr_reader :start_date, :end_date
+
+      HIV_PROGRAM_ID = 1
+      ARV_NUMBER_TYPE_ID = 4
+
+      def initialize(start_date:, end_date:, **_)
+        @start_date = start_date
+        @end_date = end_date
+      end
+
+      def find_report
+        ::DrugOrder.joins(:order)
+                   .joins('INNER JOIN encounter USING (encounter_id)')
+                   .joins('LEFT JOIN patient_identifier ON patient_identifier.patient_id = orders.patient_id')
+                   .where(drug: dtg_drugs,
+                          encounter: { program_id: HIV_PROGRAM_ID },
+                          patient_identifier: { identifier_type: ARV_NUMBER_TYPE_ID })
+                   .where('start_date BETWEEN ? AND ?', start_date, end_date)
+                   .group('orders.patient_id')
+                   .select('identifier')
+                   .map(&:identifier)
+      end
+
+      private
+
+      def dtg_drugs
+        ::Drug.where(concept_id: ::ConceptName.find_by_name('Dolutegravir').concept_id)
+      end
+    end
+  end
+end

data/app/services/malawi_hiv_program_reports/clinic/patients_on_treatment.rb

@@ -0,0 +1,42 @@
+# frozen_string_literal: true
+
+# Reports on all patients that were on treatment in given time period
+# regardless of whether they have a terminal state or not within the
+# period.
+module MalawiHivProgramReports
+  module Clinic
+    class PatientsOnTreatment
+      attr_reader :start_date, :end_date
+
+      def initialize(start_date:, end_date:)
+        @start_date = start_date
+        @end_date = end_date
+      end
+
+      # Returns patients that were on treatment within the given time period.
+      def self.within(start_date, end_date)
+        sql_conditions =
+          <<~SQL
+            ((start_date >= :start_date AND start_date <= :end_date)
+              OR (end_date >= :start_date AND end_date <= :end_date)
+              OR (start_date < :start_date AND end_date IS NULL))
+            AND state = :state
+          SQL
+
+        on_arvs = ::PatientState.where(sql_conditions, start_date:,
+                                                       end_date:,
+                                                       state: ::ArtService::Constants::States::ON_ANTIRETROVIRALS)
+
+        ::PatientProgram.select('DISTINCT patient_program.patient_id')
+                        .joins(:patient_states)
+                        .merge(on_arvs)
+                        .where(program_id: ::ArtService::Constants::PROGRAM_ID)
+      end
+
+      # We an interface to satisfy, let's be good citizens
+      def find_report
+        within(start_date, end_date).map(&:patient_id)
+      end
+    end
+  end
+end

data/app/services/malawi_hiv_program_reports/clinic/patients_with_outdated_demographics.rb

@@ -0,0 +1,173 @@
+# frozen_string_literal: true
+
+# Retrieves all current(neither dead nor transferred out) patients missing
+# any demographics or haven't had their demographics updated since the
+# given date
+module MalawiHivProgramReports
+  module Clinic
+    class PatientsWithOutdatedDemographics
+      attr_reader :date, :variant
+
+      def initialize(start_date:, variant: 'poc', **_kwargs)
+        @date = start_date
+        @variant = parse_variant(variant)
+      end
+
+      def find_report
+        patients = if variant == 'poc'
+                     poc_patients_missing_demographics
+                   else
+                     emastercard_patients_missing_demographics
+                   end
+
+        patients.collect do |patient|
+          {
+            patient_id: patient.patient_id,
+            arv_number: patient.arv_number,
+            given_name: patient.given_name,
+            family_name: patient.family_name,
+            birthdate: patient[:birthdate],
+            gender: patient[:gender],
+            current_village: patient.current_village,
+            current_traditional_authority: patient.current_traditional_authority,
+            current_district: patient.current_district,
+            home_village: patient.home_village,
+            home_traditional_authority: patient.home_traditional_authority,
+            home_district: patient.home_district,
+            landmark: patient.landmark,
+            address_last_updated_date: patient.address_last_updated_date
+          }
+        end
+      end
+
+      # Find all patients missing any of the following variables:
+      #   - birthdate
+      #   - gender
+      #   - name
+      #   - address
+      def poc_patients_missing_demographics
+        quoted_date = ActiveRecord::Base.connection.quote(date)
+
+        ::Patient.find_by_sql(
+          <<~SQL
+            SELECT patient.patient_id AS patient_id,
+                   patient_identifier.identifier AS arv_number,
+                   person_name.given_name AS given_name,
+                   person_name.family_name AS family_name,
+                   person.birthdate AS birthdate,
+                   person.gender AS gender,
+                   person_address.city_village AS current_village,
+                   person_address.township_division AS current_traditional_authority,
+                   person_address.state_province AS current_district,
+                   person_address.neighborhood_cell AS home_village,
+                   person_address.county_district AS home_traditional_authority,
+                   person_address.address2 AS home_district,
+                   landmark.value AS landmark,
+                   person_address.date_created AS address_last_updated_date
+            FROM patient
+            INNER JOIN person ON person.person_id = patient.patient_id AND person.voided = 0
+            INNER JOIN patient_program ON patient_program.patient_id = patient.patient_id AND patient_program.program_id = 1
+            INNER JOIN patient_state ON patient_state.patient_program_id = patient_program.patient_program_id
+            LEFT JOIN patient_identifier ON patient_identifier.patient_id = patient.patient_id
+              AND patient_identifier.voided = 0 AND patient_identifier.identifier_type = #{arv_number_id}
+            LEFT JOIN person_name ON person_name.person_id = patient.patient_id AND person_name.voided = 0
+            LEFT JOIN person_address ON person_address.person_id = patient.patient_id AND person_address.voided = 0
+            LEFT JOIN person_attribute landmark ON landmark.person_id = patient.patient_id
+              AND landmark.person_attribute_type_id = #{landmark_attribute_type_id}
+            WHERE patient.voided = 0
+              AND (patient_state.state != #{died_state_id}
+                   OR (patient_state.state = #{transferred_out_state_id} AND patient_state.start_date < #{quoted_date}
+                       AND (patient_state.end_date IS NULL OR patient_state.end_date > #{quoted_date})))
+              AND ((person.birthdate IS NULL OR TRIM(COALESCE(person.gender, '')) = '')
+                   OR (TRIM(COALESCE(person_name.given_name, '')) = '' OR TRIM(COALESCE(person_name.family_name, '')) = '')
+                   OR (TRIM(COALESCE(person_address.city_village, '')) = ''
+                       OR TRIM(COALESCE(person_address.township_division, '')) = ''
+                       OR TRIM(COALESCE(person_address.state_province, '')) = ''
+                       OR TRIM(COALESCE(person_address.neighborhood_cell, '') = '')
+                       OR TRIM(COALESCE(person_address.county_district, '') = '')
+                       OR TRIM(COALESCE(person_address.address2, '') = '')
+                       OR person_address.date_created < #{quoted_date}))
+            GROUP BY patient.patient_id
+          SQL
+        )
+      end
+
+      # Find all patients missing any of the following variables:
+      #   - birthdate
+      #   - gender
+      #   - name
+      #   - landmark
+      #
+      # NOTE: Old emastercard application did not collect a detailed and
+      # properly formatted address. The address was collected as free text and
+      # there was no standard provided for the address thus it's treated as
+      # a landmark by this system. Even for the new eMastercard application
+      # running atop this API, a free text alternative is provided if the
+      def emastercard_patients_missing_demographics
+        quoted_date = ActiveRecord::Base.connection.quote(date.to_s)
+
+        ::Patient.find_by_sql(
+          <<~SQL
+            SELECT patient.patient_id AS patient_id,
+                   patient_identifier.identifier AS arv_number,
+                   person_name.given_name AS given_name,
+                   person_name.family_name AS family_name,
+                   person.birthdate AS birthdate,
+                   person.gender AS gender,
+                   person_address.city_village AS current_village,
+                   person_address.township_division AS current_traditional_authority,
+                   person_address.state_province AS current_district,
+                   person_address.neighborhood_cell AS home_village,
+                   person_address.county_district AS home_traditional_authority,
+                   person_address.address2 AS home_district,
+                   landmark.value AS landmark,
+                   person_address.date_created AS address_last_updated_date
+            FROM patient
+            INNER JOIN person ON person.person_id = patient.patient_id AND person.voided = 0
+            INNER JOIN patient_program ON patient_program.patient_id = patient.patient_id AND patient_program.program_id = 1
+            INNER JOIN patient_state ON patient_state.patient_program_id = patient_program.patient_program_id
+            LEFT JOIN patient_identifier ON patient_identifier.patient_id = patient.patient_id
+              AND patient_identifier.voided = 0 AND patient_identifier.identifier_type = #{arv_number_id}
+            LEFT JOIN person_name ON person_name.person_id = patient.patient_id AND person_name.voided = 0
+            LEFT JOIN person_address ON person_address.person_id = patient.patient_id AND person_address.voided = 0
+            LEFT JOIN person_attribute landmark ON landmark.person_id = patient.patient_id
+              AND landmark.person_attribute_type_id = #{landmark_attribute_type_id}
+            WHERE patient.voided = 0
+              AND (patient_state.state != #{died_state_id}
+                   OR (patient_state.state = #{transferred_out_state_id} AND patient_state.start_date < #{quoted_date}
+                       AND (patient_state.end_date IS NULL OR patient_state.end_date > #{quoted_date})))
+              AND ((person.birthdate IS NULL OR TRIM(COALESCE(person.gender, '')) = '')
+                   OR (TRIM(COALESCE(person_name.given_name, '')) = '' OR TRIM(COALESCE(person_name.family_name, '')) = '')
+                   OR (TRIM(COALESCE(landmark.value, '')) = '' OR landmark.date_created < #{quoted_date}))
+            GROUP BY patient.patient_id
+          SQL
+        )
+      end
+
+      def arv_number_id
+        @arv_number_id ||= ::PatientIdentifierType.find_by(name: 'ARV Number').patient_identifier_type_id
+      end
+
+      def died_state_id
+        @died_state_id ||= ::ProgramWorkflowState.find_by_name_and_program(name: 'Died', program_id: 1).id
+      end
+
+      def transferred_out_state_id
+        @transferred_out_state_id ||= ::ProgramWorkflowState.find_by_name_and_program(name: 'Patient transferred out',
+                                                                                      program_id: 1).id
+      end
+
+      def landmark_attribute_type_id
+        @landmark_attribute_type_id ||= ::PersonAttributeType.find_by_name('Landmark Or Plot Number').id
+      end
+
+      def parse_variant(variant)
+        variant = variant.downcase
+
+        return variant if %w[poc emastercard].include?(variant)
+
+        raise ::InvalidParameterError, "Invalid report variant '#{variant}'; expected poc or emastercard"
+      end
+    end
+  end
+end

data/app/services/malawi_hiv_program_reports/clinic/pregnant_patients.rb

@@ -0,0 +1,91 @@
+# frozen_string_literal: true
+
+# Retrieve all pregnant females in a given time period
+module MalawiHivProgramReports
+  module Clinic
+    class PregnantPatients
+      attr_reader :start_date, :end_date
+
+      include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+
+      def initialize(start_date:, end_date:, **kwargs)
+        @start_date = start_date
+        @end_date = end_date
+        @occupation = kwargs[:occupation]
+      end
+
+      def find_report
+        all_pregnant.map do |patient|
+          {
+            patient_id: patient.patient_id,
+            arv_number: patient.arv_number,
+            given_name: patient.given_name,
+            family_name: patient.family_name,
+            gender: patient.gender,
+            birthdate: patient.birthdate,
+            last_reported_date: patient.last_reported_date
+          }
+        end
+      end
+
+      private
+
+      def all_pregnant
+        str_start_date = ActiveRecord::Base.connection.quote(start_date)
+        str_end_date = ActiveRecord::Base.connection.quote(end_date)
+
+        ::Person.find_by_sql(
+          <<~SQL
+            SELECT obs.person_id AS patient_id,
+                   patient_identifier.identifier AS arv_number,
+                   given_name,
+                   family_name,
+                   gender,
+                   birthdate,
+                   obs.obs_datetime AS last_reported_date
+            FROM obs
+            INNER JOIN person ON person.person_id = obs.person_id
+            INNER JOIN person_name ON person_name.person_id = obs.person_id
+            LEFT JOIN patient_identifier ON patient_identifier.patient_id = obs.person_id
+              AND patient_identifier.identifier_type = #{arv_number_type_id}
+            INNER JOIN encounter ON encounter.encounter_id = obs.encounter_id
+              AND encounter.program_id = #{hiv_program_id}
+            LEFT JOIN (#{current_occupation_query}) a ON a.person_id = obs.person_id
+            WHERE obs.concept_id IN (#{pregnant_concepts.select(:concept_id).to_sql})
+              AND obs.value_coded = #{yes_concept_id}
+              AND obs.person_id IN (#{patients_on_treatment.to_sql})
+              AND obs.obs_datetime = (
+                SELECT MAX(obs_date.obs_datetime) FROM obs obs_date
+                  INNER JOIN encounter USING (encounter_id)
+                WHERE obs_date.concept_id IN (#{pregnant_concepts.select(:concept_id).to_sql})
+                  AND DATE(obs_date.obs_datetime) BETWEEN #{str_start_date} AND #{str_end_date}
+                  AND obs_date.person_id = obs.person_id
+                  AND program_id = #{hiv_program_id}
+              ) #{%w[Military Civilian].include?(@occupation) ? 'AND' : ''} #{occupation_filter(occupation: @occupation, field_name: 'value', table_name: 'a', include_clause: false)}
+            GROUP BY obs.person_id
+          SQL
+        )
+      end
+
+      def patients_on_treatment
+        PatientsOnTreatment.within(start_date, end_date)
+      end
+
+      def pregnant_concepts
+        ::ConceptName.where(name: ['Is patient pregnant?', 'patient_pregnant'])
+      end
+
+      def yes_concept_id
+        ::ConceptName.find_by_name('Yes').concept_id
+      end
+
+      def arv_number_type_id
+        ::PatientIdentifierType.find_by_name('ARV Number').id
+      end
+
+      def hiv_program_id
+        ::ArtService::Constants::PROGRAM_ID
+      end
+    end
+  end
+end

data/app/services/malawi_hiv_program_reports/clinic/regimen_dispensation_data.rb

@@ -0,0 +1,282 @@
+# frozen_string_literal: true
+
+# this report is used to generate regimen data
+module MalawiHivProgramReports
+  module Clinic
+    class RegimenDispensationData
+      attr_reader :start_date, :end_date, :type
+      include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+      include MalawiHivProgramReports::Adapters::Moh::Custom
+      include Utils
+
+      def initialize(start_date:, end_date:, **kwargs)
+        @start_date = ActiveRecord::Base.connection.quote(start_date.to_date.strftime('%Y-%m-%d 00:00:00'))
+        @end_date = ActiveRecord::Base.connection.quote(end_date.to_date.strftime('%Y-%m-%d 23:59:59'))
+        @type = kwargs[:type]
+        @occupation = kwargs[:occupation]
+      end
+
+      def find_report
+        drop_regimen_data
+        create_filtered_data
+        process_clients
+      end
+
+      private
+
+      # rubocop:disable Metrics/AbcSize
+      def drop_regimen_data
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_current_dispensation'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_drug_dispensed'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_current_regimen_names'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_current_patient_regimen'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_reg_outcome'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_vl_results'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_current_vl_results'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_regimen_patient_weight'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_regimen_data'
+        ActiveRecord::Base.connection.execute 'DROP TABLE IF EXISTS temp_patient_start_date'
+      end
+      # rubocop:enable Metrics/AbcSize
+
+      def create_filtered_data
+        create_temp_current_dispensation
+        create_temp_drug_dispensed
+        create_temp_current_regimen
+        create_temp_current_patient_regimen
+        create_temp_patient_outcome
+        create_temp_vl_result
+        create_temp_current_vl_results
+        create_temp_regimen_patient_weight
+        create_temp_patient_start_date
+      end
+
+      def create_temp_current_dispensation
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE TABLE temp_current_dispensation
+          SELECT o.patient_id, MAX(o.start_date) AS start_date
+          FROM orders o
+          INNER JOIN drug_order od ON od.order_id = o.order_id AND od.quantity > 0 AND od.drug_inventory_id IN (SELECT drug_id FROM arv_drug)
+          LEFT JOIN (#{current_occupation_query}) a ON a.person_id = o.patient_id
+          WHERE o.start_date > #{end_date} - INTERVAL 18 MONTH AND o.start_date < #{end_date} + INTERVAL 1 DAY
+          AND o.voided = 0 #{%w[Military Civilian].include?(@occupation) ? 'AND' : ''} #{occupation_filter(occupation: @occupation, field_name: 'value', table_name: 'a', include_clause: false)}
+          AND o.order_type_id = 1 -- drug order
+          GROUP BY o.patient_id
+        SQL
+        ActiveRecord::Base.connection.execute 'create index current_disp on temp_current_dispensation (patient_id, start_date)'
+      end
+
+      def create_temp_drug_dispensed
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE table temp_drug_dispensed
+          SELECT o.patient_id, od.drug_inventory_id, d.name, o.start_date, od.quantity
+          FROM orders o
+          INNER JOIN temp_current_dispensation tcd ON tcd.patient_id = o.patient_id AND tcd.start_date = o.start_date
+          INNER JOIN drug_order od ON od.order_id = o.order_id AND od.quantity > 0 AND od.drug_inventory_id IN (SELECT drug_id FROM arv_drug)
+          INNER JOIN drug d ON d.drug_id = od.drug_inventory_id AND d.retired  = 0
+          WHERE o.voided = 0
+          AND o.order_type_id = 1 -- drug order
+        SQL
+        ActiveRecord::Base.connection.execute 'create index drug_disp on temp_drug_dispensed (patient_id, start_date)'
+      end
+
+      def create_temp_current_regimen
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE table temp_current_regimen_names
+          SELECT GROUP_CONCAT(drug.drug_id ORDER BY drug.drug_id ASC) AS drugs, regimen_name.name AS name
+          FROM moh_regimen_combination AS combo
+          INNER JOIN moh_regimen_combination_drug AS drug USING (regimen_combination_id)
+          INNER JOIN moh_regimen_name AS regimen_name USING (regimen_name_id)
+          GROUP BY combo.regimen_combination_id
+        SQL
+        ActiveRecord::Base.connection.execute 'create index regimen_names on temp_current_regimen_names (drugs(50))'
+      end
+
+      def create_temp_current_patient_regimen
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE table temp_current_patient_regimen
+          SELECT patient_id, name
+          FROM temp_current_regimen_names tcrn
+          INNER JOIN (
+            SELECT patient_id, GROUP_CONCAT(drug_inventory_id ORDER BY drug_inventory_id ASC) AS drugs
+            FROM temp_drug_dispensed
+            GROUP BY patient_id
+          ) d ON d.drugs = tcrn.drugs
+        SQL
+        ActiveRecord::Base.connection.execute 'create index patient_regimen on temp_current_patient_regimen (patient_id)'
+      end
+
+      def create_temp_patient_outcome
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE TABLE temp_reg_outcome
+          SELECT patient_id, #{type == 'pepfar' ? "pepfar_patient_outcome(patient_id, #{end_date})" : "patient_outcome(patient_id, #{end_date})"} outcome
+          FROM temp_current_dispensation
+        SQL
+        ActiveRecord::Base.connection.execute 'create index reg_outcome on temp_reg_outcome (patient_id)'
+      end
+
+      def create_temp_vl_result
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE table temp_vl_results
+          SELECT
+            lab_result_obs.obs_datetime AS result_date,
+            CONCAT (COALESCE(measure.value_modifier, '='),' ',COALESCE(measure.value_numeric, measure.value_text, '')) AS result,
+            lab_result_obs.person_id AS patient_id
+          FROM obs AS lab_result_obs
+          INNER JOIN orders ON orders.order_id = lab_result_obs.order_id AND orders.voided = 0
+          INNER JOIN obs AS measure ON measure.obs_group_id = lab_result_obs.obs_id AND measure.voided = 0
+          INNER JOIN (
+            SELECT concept_id, name
+            FROM concept_name
+            INNER JOIN concept USING (concept_id)
+            WHERE concept.retired = 0
+            AND name NOT LIKE 'Lab test result'
+            GROUP BY concept_id
+          ) AS measure_concept ON measure_concept.concept_id = measure.concept_id
+          WHERE lab_result_obs.voided = 0
+          AND measure.person_id IN (SELECT patient_id FROM temp_reg_outcome WHERE outcome = 'On antiretrovirals')
+          AND (measure.value_numeric IS NOT NULL || measure.value_text IS NOT NULL)
+          AND lab_result_obs.obs_datetime < #{end_date} + INTERVAL 1 DAY
+          ORDER BY lab_result_obs.obs_datetime DESC
+        SQL
+        ActiveRecord::Base.connection.execute 'create index vl_result on temp_vl_results (patient_id, result_date)'
+      end
+
+      def create_temp_current_vl_results
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE TABLE temp_current_vl_results
+          SELECT t.*
+          FROM temp_vl_results t
+          LEFT JOIN temp_vl_results td ON td.patient_id = t.patient_id AND td.result_date > t.result_date
+          WHERE td.patient_id IS NULL
+        SQL
+        ActiveRecord::Base.connection.execute 'create index current_vl on temp_current_vl_results (patient_id)'
+      end
+
+      def create_temp_regimen_patient_weight
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE TABLE temp_regimen_patient_weight
+          SELECT tro.patient_id, o.value_numeric AS weight
+          FROM temp_reg_outcome tro
+          INNER JOIN (
+            SELECT person_id, MAX(obs_datetime) AS max_datetime
+            FROM obs
+            WHERE concept_id = 5089 AND voided = 0 AND obs_datetime < #{end_date} + INTERVAL 1 DAY
+            GROUP BY person_id
+          ) latest_obs ON latest_obs.person_id = tro.patient_id
+          INNER JOIN obs o ON o.person_id = latest_obs.person_id AND o.concept_id = 5089 AND o.obs_datetime = latest_obs.max_datetime AND o.voided = 0 AND o.obs_datetime < #{end_date} + INTERVAL 1 DAY
+          WHERE tro.outcome = 'On antiretrovirals'
+        SQL
+        ActiveRecord::Base.connection.execute 'create index patient_weight on temp_regimen_patient_weight (patient_id)'
+      end
+
+      def create_temp_patient_start_date
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE TABLE temp_patient_start_date
+          SELECT
+            `p`.`patient_id` AS `patient_id`,
+            cast(patient_date_enrolled(`p`.`patient_id`) as date) AS `date_enrolled`,
+            date_antiretrovirals_started(`p`.`patient_id`, min(`s`.`start_date`)) AS `earliest_start_date`
+           FROM
+              ((`patient_program` `p`
+              LEFT JOIN `person` `pe` ON ((`pe`.`person_id` = `p`.`patient_id`))
+              LEFT JOIN `patient_state` `s` ON ((`p`.`patient_program_id` = `s`.`patient_program_id`)))
+              LEFT JOIN `person` ON ((`person`.`person_id` = `p`.`patient_id`)))
+           WHERE
+            ((`p`.`voided` = 0)
+            AND (`s`.`voided` = 0)
+            AND (`p`.`program_id` = 1)
+            AND (`s`.`state` = 7))
+            AND (`s`.`start_date` < #{end_date} + INTERVAL 1 DAY)
+            AND p.patient_id IN (SELECT patient_id FROM temp_reg_outcome WHERE outcome = 'On antiretrovirals')
+          GROUP BY `p`.`patient_id`;
+        SQL
+        ActiveRecord::Base.connection.execute 'create index start_date on temp_patient_start_date (patient_id)'
+      end
+
+      def clients_alive_on_treatment
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT
+            trc.patient_id,
+            p.gender,
+            p.birthdate,
+            pn.given_name,
+            pn.family_name,
+            i.identifier arv_number,
+            tpw.weight,
+            tcvr.result_date,
+            tcvr.result,
+            tcp.name regimen,
+            trc.earliest_start_date
+          FROM temp_patient_start_date trc
+          INNER JOIN temp_current_dispensation tcd ON tcd.patient_id = trc.patient_id AND tcd.start_date BETWEEN #{@start_date} AND #{@end_date}
+          INNER JOIN person p ON p.person_id = trc.patient_id AND p.voided = 0
+          INNER JOIN person_name pn ON pn.person_id = p.person_id AND pn.voided = 0
+          LEFT JOIN patient_identifier i ON i.patient_id = p.person_id AND i.identifier_type = 4 AND i.voided = 0
+          LEFT JOIN temp_regimen_patient_weight tpw ON tpw.patient_id = trc.patient_id
+          LEFT JOIN temp_current_vl_results tcvr ON tcvr.patient_id = trc.patient_id
+          LEFT JOIN temp_current_patient_regimen tcp ON tcp.patient_id = trc.patient_id
+          GROUP BY trc.patient_id
+        SQL
+      end
+
+      def alive_clients
+        clients = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT trc.patient_id
+          FROM temp_reg_outcome trc
+          INNER JOIN person p ON p.person_id = trc.patient_id AND p.voided = 0
+          where trc.outcome = 'On antiretrovirals' AND LEFT(p.gender, 1) = 'F'
+        SQL
+        clients.map { |client| client['patient_id'] }
+      end
+
+      def process_clients
+        clients = {}
+        @maternal_status = maternal_status
+        clients_alive_on_treatment.each do |client|
+          clients[client['patient_id']] = {
+            arv_number: client['arv_number'],
+            given_name: client['given_name'],
+            family_name: client['family_name'],
+            birthdate: client['birthdate'],
+            gender: client['gender'] == 'M' ? 'M' : fetch_maternal_status(client['patient_id']),
+            current_regimen: client['regimen'],
+            current_weight: client['weight'],
+            art_start_date: client['earliest_start_date'],
+            medication: fetch_medication(client['patient_id']),
+            vl_result: client['result'],
+            vl_result_date: client['result_date']
+          }
+        end
+        clients
+      end
+
+      def maternal_status
+        MalawiHivProgramReports::Pepfar::ViralLoadCoverage2.new(start_date: @start_date,
+                                                                end_date: @end_date).vl_maternal_status(alive_clients)
+      end
+
+      def fetch_maternal_status(patient_id)
+        return nil if patient_id.blank?
+
+        gender = 'FNP'
+        gender = 'FP' if @maternal_status[:FP].include?(patient_id)
+        gender = 'FBf' if @maternal_status[:FBf].include?(patient_id)
+        gender
+      end
+
+      def fetch_medication(patient_id)
+        result = []
+        data = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT tdd.name, DATE(tdd.start_date) start_date, tdd.quantity
+          FROM temp_drug_dispensed tdd
+          WHERE tdd.patient_id = #{patient_id}
+        SQL
+        data.each do |row|
+          result << { medication: row['name'], start_date: row['start_date'], quantity: row['quantity'] }
+        end
+        result
+      end
+    end
+  end
+end