malawi_hiv_program_reports 1.0.1 → 1.0.2

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

@@ -0,0 +1,494 @@
+# frozen_string_literal: true
+
+##
+# Family planning, action to take
+# It should pull data for 6 month back e.g when the report is generated for the month of June,
+# the report must pick clients who started TPT in the month of December
+# it must be drillable
+module MalawiHivProgramReports
+  module Clinic
+    class TptOutcome
+      include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+      include MalawiHivProgramReports::Utils::ModelUtils
+      include MalawiHivProgramReports::Pepfar::Utils
+
+      def initialize(start_date:, end_date:, **kwargs)
+        @start_date = start_date.to_date
+        @end_date = end_date.to_date
+        @tb_prev = Pepfar::TbPrev3.new(start_date: @start_date, end_date: @end_date)
+        @occupation = kwargs[:occupation]
+      end
+
+      def find_report
+        report = init_report
+        @param = 'tpt_type'
+        load_patients_into_report report, process_tpt_clients
+        response = []
+        report.each do |key, value|
+          response << { age_group: key, tpt_type: '3HP', **value['3HP'] }
+          response << { age_group: key, tpt_type: '6H', **value['6H'] }
+        end
+        response
+      end
+
+      def moh_report(report, clients, start_date, end_date)
+        @first_day_of_month = start_date.to_date
+        @last_day_of_month = end_date.to_date
+        tpt_clients = process_tpt_clients(clients)
+        @param = 'gender'
+        load_moh_patients_into_report report, tpt_clients
+      end
+
+      private
+
+      TPT_TYPES = %w[3HP 6H].freeze
+
+      def init_report
+        pepfar_age_groups.each_with_object({}) do |age_group, report|
+          next if age_group == 'Unknown'
+
+          report[age_group] = TPT_TYPES.each_with_object({}) do |tpt_type, tpt_report|
+            tpt_report[tpt_type] = {
+              started_tpt_new: [],
+              started_tpt_prev: [],
+              completed_tpt_new: [],
+              completed_tpt_prev: [],
+              not_completed_tpt: [],
+              died: [],
+              stopped: [],
+              defaulted: [],
+              transfer_out: [],
+              confirmed_tb: [],
+              pregnant: [],
+              breast_feeding: [],
+              skin_rash: [],
+              peripheral_neuropathy: [],
+              yellow_eyes: [],
+              nausea: [],
+              dizziness: []
+            }
+          end
+        end
+      end
+
+      def patient_breast_feeding?(patient_id, last_tpt)
+        ::Observation.where(person_id: patient_id, concept_id: breast_feeding_concept_id,
+                            value_coded: yes_concept_id)
+                     .where('DATE(obs_datetime) > DATE(?) AND DATE(obs_datetime) < DATE(?) + INTERVAL 1 DAY', last_tpt&.to_date, @end_date.to_date)
+                     .exists?
+      end
+
+      def patient_skin_rash?(patient_id, last_tpt)
+        ::Observation.where(person_id: patient_id, concept_id: drug_induced_concept_id,
+                            value_coded: skin_rash_concept_id)
+                     .where('DATE(obs_datetime) > DATE(?) AND DATE(obs_datetime) < DATE(?) + INTERVAL 1 DAY', last_tpt&.to_date, @end_date.to_date)
+                     .where("value_drug IN (#{tpt_actual_drugs})")
+                     .exists?
+      end
+
+      def patient_peripheral_neuropathy?(patient_id, last_tpt)
+        ::Observation.where(person_id: patient_id, concept_id: drug_induced_concept_id,
+                            value_coded: peripheral_neuropathy_concept_id)
+                     .where('DATE(obs_datetime) > DATE(?) AND DATE(obs_datetime) < DATE(?) + INTERVAL 1 DAY', last_tpt&.to_date, @end_date.to_date)
+                     .where("value_drug IN (#{tpt_actual_drugs})")
+                     .exists?
+      end
+
+      def patient_pregnant?(patient_id, last_tpt)
+        ::Observation.where(person_id: patient_id, concept_id: pregnant_concept_id,
+                            value_coded: yes_concept_id)
+                     .where('DATE(obs_datetime) > DATE(?) AND DATE(obs_datetime) < DATE(?) + INTERVAL 1 DAY', last_tpt&.to_date, @end_date.to_date)
+                     .exists?
+      end
+
+      def patient_on_tb_treatment?(patient_id, last_tpt)
+        ::Observation.where(person_id: patient_id, concept_id: tb_treatment_concept_id,
+                            value_coded: yes_concept_id)
+                     .where('DATE(obs_datetime) > DATE(?) AND DATE(obs_datetime) < DATE(?) + INTERVAL 1 DAY', last_tpt&.to_date, @end_date.to_date)
+                     .exists?
+      end
+
+      def patient_yellow_eyes?(patient_id, last_tpt)
+        ::Observation.where(person_id: patient_id, concept_id: drug_induced_concept_id,
+                            value_coded: yellow_eyes_concept_id)
+                     .where('DATE(obs_datetime) > DATE(?) AND DATE(obs_datetime) < DATE(?) + INTERVAL 1 DAY', last_tpt&.to_date, @end_date.to_date)
+                     .where("value_drug IN (#{tpt_actual_drugs})")
+                     .exists?
+      end
+
+      def patient_nausea?(patient_id, last_tpt)
+        ::Observation.where(person_id: patient_id, concept_id: drug_induced_concept_id,
+                            value_coded: nausea_concept_id)
+                     .where('DATE(obs_datetime) > DATE(?) AND DATE(obs_datetime) < DATE(?) + INTERVAL 1 DAY', last_tpt&.to_date, @end_date.to_date)
+                     .where("value_drug IN (#{tpt_actual_drugs})")
+                     .exists?
+      end
+
+      def patient_dizziness?(patient_id, last_tpt)
+        ::Observation.where(person_id: patient_id, concept_id: drug_induced_concept_id,
+                            value_coded: dizziness_concept_id)
+                     .where('DATE(obs_datetime) > DATE(?) AND DATE(obs_datetime) < DATE(?) + INTERVAL 1 DAY', last_tpt&.to_date, @end_date.to_date)
+                     .where("value_drug IN (#{tpt_actual_drugs})")
+                     .exists?
+      end
+
+      def pregnant_concept_id
+        @pregnant_concept_id ||= concept_name_to_id('Is patient pregnant?')
+      end
+
+      def tb_treatment_concept_id
+        @tb_treatment_concept_id ||= concept_name_to_id('TB treatment')
+      end
+
+      def yes_concept_id
+        @yes_concept_id ||= concept_name_to_id('Yes')
+      end
+
+      def breast_feeding_concept_id
+        @breast_feeding_concept_id ||= concept_name_to_id('Breast feeding?')
+      end
+
+      def skin_rash_concept_id
+        @skin_rash_concept_id ||= concept_name_to_id('Skin rash')
+      end
+
+      def peripheral_neuropathy_concept_id
+        @peripheral_neuropathy_concept_id ||= concept_name_to_id('Peripheral neuropathy')
+      end
+
+      def yellow_eyes_concept_id
+        @yellow_eyes_concept_id ||= concept_name_to_id('Yellow eyes')
+      end
+
+      def nausea_concept_id
+        @nausea_concept_id ||= concept_name_to_id('Nausea')
+      end
+
+      def dizziness_concept_id
+        @dizziness_concept_id ||= concept_name_to_id('Dizziness')
+      end
+
+      def drug_induced_concept_id
+        @drug_induced_concept_id ||= concept_name_to_id('Drug Induced')
+      end
+
+      def tpt_clients
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT
+            pp.patient_id,
+            patient_outcome(p.person_id, DATE('#{@end_date}')) AS outcome,
+            p.gender,
+            p.birthdate,
+            disaggregated_age_group(p.birthdate, DATE('#{@end_date}')) AS age_group,
+            DATE(COALESCE(art_start_date_obs.value_datetime, MIN(art_order.start_date))) AS earliest_start_date,
+            GROUP_CONCAT(DISTINCT o.concept_id SEPARATOR ',') AS drug_concepts,
+            CASE
+              WHEN count(DISTINCT o.concept_id) >  1 THEN '3HP'
+              WHEN o.concept_id = 10565 THEN '3HP'
+              ELSE '6H'
+            END AS tpt_type
+          FROM patient_program pp
+          INNER JOIN patient_state ps ON ps.patient_program_id = pp.patient_program_id AND ps.voided = 0 AND ps.state = 7
+          INNER JOIN person p ON p.person_id = pp.patient_id AND p.voided = 0
+          INNER JOIN encounter e ON e.patient_id = pp.patient_id
+            AND e.encounter_type = 25 /* Treatment */
+            AND e.voided = 0
+            AND e.program_id = 1 /* HIV PROGRAM */
+          INNER JOIN orders o ON o.encounter_id = e.encounter_id
+            AND o.order_type_id = #{::OrderType.find_by_name('Drug order').id}
+            AND o.voided = 0
+            AND o.concept_id IN (#{tpt_drugs.to_sql})
+          INNER JOIN drug_order dor ON dor.order_id = o.order_id AND dor.quantity > 0
+          INNER JOIN (
+            SELECT e.patient_id
+            FROM encounter e
+            INNER JOIN orders o ON o.encounter_id = e.encounter_id
+              AND o.voided = 0
+              AND o.order_type_id = #{::OrderType.find_by_name('Drug order').id}
+              AND o.concept_id IN (#{tpt_drugs.to_sql})
+              AND DATE(o.start_date) BETWEEN #{first_day_of_month} AND DATE(#{last_day_of_month})
+            INNER JOIN drug_order dor ON dor.order_id = o.order_id AND dor.quantity > 0
+            WHERE e.encounter_type = 25 /* Treatment */
+              AND e.voided = 0
+              AND e.program_id = 1 /* HIV PROGRAM */
+              AND DATE(e.encounter_datetime) BETWEEN #{first_day_of_month} AND DATE(#{last_day_of_month})
+            GROUP BY e.patient_id
+          ) clients_on_tpt ON clients_on_tpt.patient_id = e.patient_id
+          LEFT JOIN encounter AS clinic_registration_encounter
+            ON clinic_registration_encounter.encounter_type = (
+              SELECT encounter_type_id FROM encounter_type WHERE name = 'HIV CLINIC REGISTRATION' LIMIT 1
+            )
+            AND clinic_registration_encounter.patient_id = pp.patient_id
+            AND clinic_registration_encounter.program_id = pp.program_id
+            AND clinic_registration_encounter.encounter_datetime < DATE('#{@end_date}') + INTERVAL 1 DAY
+            AND clinic_registration_encounter.voided = 0
+          INNER JOIN orders AS art_order
+            ON art_order.patient_id = pp.patient_id
+            /* AND art_order.encounter_id = prescription_encounter.encounter_id */
+            AND art_order.concept_id IN (SELECT concept_id FROM concept_set WHERE concept_set = 1085)
+            AND art_order.start_date < DATE('#{@end_date}') + INTERVAL 1 DAY
+            AND art_order.order_type_id IN (SELECT order_type_id FROM order_type WHERE name = 'Drug order')
+            AND art_order.start_date >= DATE('1901-01-01')
+            AND art_order.voided = 0
+          LEFT JOIN obs AS art_start_date_obs
+            ON art_start_date_obs.concept_id = 2516
+            AND art_start_date_obs.person_id = pp.patient_id
+            AND art_start_date_obs.voided = 0
+            AND art_start_date_obs.obs_datetime < (DATE('#{@end_date}') + INTERVAL 1 DAY)
+            AND art_start_date_obs.encounter_id = clinic_registration_encounter.encounter_id
+          LEFT JOIN (#{current_occupation_query}) AS a ON a.person_id = pp.patient_id
+          WHERE pp.program_id = 1 /* HIV PROGRAM */
+            AND pp.patient_id  NOT IN (
+              /* External consultations */
+              SELECT DISTINCT registration_encounter.patient_id
+              FROM patient_program
+              INNER JOIN program ON program.name = 'HIV PROGRAM'
+              INNER JOIN encounter AS registration_encounter
+                ON registration_encounter.patient_id = patient_program.patient_id
+                AND registration_encounter.program_id = patient_program.program_id
+                AND registration_encounter.encounter_datetime < DATE('#{@end_date}') + INTERVAL 1 DAY
+                AND registration_encounter.voided = 0
+              INNER JOIN (
+                SELECT MAX(encounter.encounter_datetime) AS encounter_datetime, encounter.patient_id
+                FROM encounter
+                INNER JOIN encounter_type
+                  ON encounter_type.encounter_type_id = encounter.encounter_type
+                  AND encounter_type.name = 'Registration'
+                INNER JOIN program
+                  ON program.program_id = encounter.program_id
+                  AND program.name = 'HIV PROGRAM'
+                WHERE encounter.encounter_datetime < DATE('#{@end_date}') AND encounter.voided = 0
+                GROUP BY encounter.patient_id
+              ) AS max_registration_encounter
+                ON max_registration_encounter.patient_id = registration_encounter.patient_id
+                AND max_registration_encounter.encounter_datetime = registration_encounter.encounter_datetime
+              INNER JOIN obs AS patient_type_obs
+                ON patient_type_obs.encounter_id = registration_encounter.encounter_id
+                AND patient_type_obs.concept_id IN (SELECT concept_id FROM concept_name WHERE name = 'Type of patient' AND voided = 0)
+                AND patient_type_obs.value_coded IN (SELECT concept_id FROM concept_name WHERE name IN ('Drug refill', 'External consultation') AND voided = 0)
+                AND patient_type_obs.voided = 0
+              WHERE patient_program.voided = 0
+            )
+            AND pp.voided = 0 #{%w[Military Civilian].include?(@occupation) ? 'AND' : ''} #{occupation_filter(occupation: @occupation, field_name: 'value', table_name: 'a', include_clause: false)}
+            AND DATE(o.start_date)<= DATE('#{@end_date}')
+            GROUP BY pp.patient_id
+        SQL
+      end
+
+      def process_tpt_clients(patients = nil)
+        clients = []
+        (patients || tpt_clients || []).each do |client|
+          result = @tb_prev.fetch_individual_report(client['patient_id'])
+          next if result.blank?
+          next if result['tpt_initiation_date'].to_date < first_day_of_month.to_date
+
+          client['start_date'] = result['tpt_initiation_date']
+          client['last_dispense_date'] = result['last_dispensed_date']
+          client['total_pills_taken'] = result['total_pills_taken']
+          client['total_days_on_medication'] = result['total_days_on_medication']
+          client['tpt_type'] = @tb_prev.patient_on_3hp?(result) ? '3HP' : '6H'
+          client['drug_concepts'] = result['drug_concepts']
+
+          clients << client
+        end
+        clients
+      end
+
+      # def tpt_clients
+      #   ActiveRecord::Base.connection.select_all <<~SQL
+      #     SELECT
+      #       p.person_id AS patient_id,
+      #       DATE(min(o.start_date)) AS start_date,
+      #       DATE(max(o.start_date)) AS last_dispense_date,
+      #       patient_outcome(p.person_id, DATE('#{@end_date}')) AS outcome,
+      #       SUM(d.quantity) AS total_pills_taken,
+      #       SUM(DATEDIFF(o.auto_expire_date, o.start_date)) AS total_days_on_medication,
+      #       p.gender,
+      #       p.birthdate,
+      #       disaggregated_age_group(p.birthdate, DATE('#{@end_date}')) AS age_group,
+      #       GROUP_CONCAT(DISTINCT o.concept_id SEPARATOR ',') AS drug_concepts,
+      #       CASE
+      #         WHEN count(DISTINCT o.concept_id) >  1 THEN '3HP'
+      #         WHEN o.concept_id = 10565 THEN '3HP'
+      #         ELSE '6H'
+      #       END AS tpt_type
+      #     FROM person p
+      #     INNER JOIN encounter e
+      #       ON e.patient_id = p.person_id
+      #       AND e.encounter_type = #{::EncounterType.find_by_name('Treatment').id}
+      #       AND e.voided = 0
+      #       AND e.program_id = #{::Program.find_by_name('HIV PROGRAM').id}
+      #       AND e.encounter_datetime >= DATE('#{@start_date}') - INTERVAL 6 MONTH
+      #       AND e.encounter_datetime <= DATE('#{@start_date}')
+      #     INNER JOIN orders o
+      #       ON o.encounter_id = e.encounter_id
+      #       AND o.concept_id IN (#{tpt_drugs.to_sql})
+      #       AND o.start_date >= DATE('#{@start_date}') - INTERVAL 6 MONTH
+      #       AND o.start_date <= DATE('#{@end_date}')
+      #       AND o.voided = 0
+      #       AND o.order_type_id = #{::OrderType.find_by_name('Drug order').id}
+      #     INNER JOIN drug_order d ON d.order_id = o.order_id AND d.quantity > 0
+      #     WHERE p.voided = 0
+      #     AND p.person_id NOT IN (
+      #       SELECT p.person_id
+      #       FROM person p
+      #       INNER JOIN encounter e
+      #         ON e.patient_id = p.person_id
+      #         AND e.encounter_type = #{::EncounterType.find_by_name('Treatment').id}
+      #         AND e.voided = 0
+      #         AND e.program_id = #{::Program.find_by_name('HIV PROGRAM').id}
+      #       INNER JOIN orders o
+      #         ON o.patient_id = e.patient_id
+      #         AND o.concept_id IN (#{tpt_drugs.to_sql})
+      #         AND o.voided = 0
+      #         AND o.order_type_id = #{::OrderType.find_by_name('Drug order').id}
+      #       INNER JOIN drug_order d ON d.order_id = o.order_id AND d.quantity > 0
+      #       WHERE p.voided = 0
+      #         AND e.encounter_datetime < '#{@start_date - 6.months}'
+      #         AND e.encounter_datetime >= '#{@start_date - 15.months}'
+      #     )
+      #     AND p.person_id NOT IN (
+      #       /* External consultations */
+      #       SELECT DISTINCT registration_encounter.patient_id
+      #       FROM patient_program
+      #       INNER JOIN program ON program.name = 'HIV PROGRAM'
+      #       INNER JOIN encounter AS registration_encounter
+      #         ON registration_encounter.patient_id = patient_program.patient_id
+      #         AND registration_encounter.program_id = patient_program.program_id
+      #         AND registration_encounter.encounter_datetime < DATE('#{@end_date}') + INTERVAL 1 DAY
+      #         AND registration_encounter.voided = 0
+      #       INNER JOIN (
+      #         SELECT MAX(encounter.encounter_datetime) AS encounter_datetime, encounter.patient_id
+      #         FROM encounter
+      #         INNER JOIN encounter_type
+      #           ON encounter_type.encounter_type_id = encounter.encounter_type
+      #           AND encounter_type.name = 'Registration'
+      #         INNER JOIN program
+      #           ON program.program_id = encounter.program_id
+      #           AND program.name = 'HIV PROGRAM'
+      #         WHERE encounter.encounter_datetime < DATE('#{@end_date}') AND encounter.voided = 0
+      #         GROUP BY encounter.patient_id
+      #       ) AS max_registration_encounter
+      #         ON max_registration_encounter.patient_id = registration_encounter.patient_id
+      #         AND max_registration_encounter.encounter_datetime = registration_encounter.encounter_datetime
+      #       INNER JOIN obs AS patient_type_obs
+      #         ON patient_type_obs.encounter_id = registration_encounter.encounter_id
+      #         AND patient_type_obs.concept_id IN (SELECT concept_id FROM concept_name WHERE name = 'Type of patient' AND voided = 0)
+      #         AND patient_type_obs.value_coded IN (SELECT concept_id FROM concept_name WHERE name IN ('Drug refill', 'External consultation') AND voided = 0)
+      #         AND patient_type_obs.voided = 0
+      #       WHERE patient_program.voided = 0
+      #     )
+      #     GROUP BY p.person_id
+      #   SQL
+      # end
+
+      def load_patients_into_report(report, patients)
+        patients.each do |patient|
+          new_on_art = patient_new_on_art?(patient)
+          common_reponse(patient)
+          if new_on_art
+            report[patient['age_group']][patient[@param]][:started_tpt_new] << @common_response
+          else
+            report[patient['age_group']][patient[@param]][:started_tpt_prev] << @common_response
+          end
+
+          if patient_completed_tpt?(patient, patient['tpt_type'])
+            report[patient['age_group']][patient[@param]][:completed_tpt_new] << @common_response if new_on_art
+            report[patient['age_group']][patient[@param]][:completed_tpt_prev] << @common_response unless new_on_art
+          else
+            report[patient['age_group']][patient[@param]][:not_completed_tpt] << @common_response
+            process_outcomes report, patient
+          end
+        end
+      end
+
+      def load_moh_patients_into_report(report, patients)
+        patients.each do |patient|
+          common_reponse(patient)
+          report[patient['age_group']][patient[@param]][:started_tpt] << @common_response
+          if patient_completed_tpt?(patient, patient['tpt_type'])
+            report[patient['age_group']][patient[@param]][:completed_tpt] << @common_response
+          else
+            report[patient['age_group']][patient[@param]][:not_completed_tpt] << @common_response
+            process_outcomes report, patient
+          end
+        end
+      end
+
+      def process_outcomes(report, patient)
+        process_patient_conditions report, patient
+        return if @condition
+
+        case patient['outcome']
+        when 'Patient died'
+          report[patient['age_group']][patient[@param]][:died] << @common_response
+        when 'Patient transferred out'
+          report[patient['age_group']][patient[@param]][:transfer_out] << @common_response
+        when 'Treatment stopped'
+          report[patient['age_group']][patient[@param]][:stopped] << @common_response
+        when 'Defaulted'
+          report[patient['age_group']][patient[@param]][:defaulted] << @common_response
+        else
+          process_patient_conditions report, patient
+        end
+      end
+
+      def process_patient_conditions(report, patient)
+        if patient_on_tb_treatment?(patient['patient_id'], patient['last_dispense_date'])
+          report[patient['age_group']][patient[@param]][:confirmed_tb] << @common_response
+        elsif patient['gender'] == 'F' && patient_pregnant?(patient['patient_id'], patient['last_dispense_date'])
+          report[patient['age_group']][patient[@param]][:pregnant] << @common_response
+          @condition = true
+          return
+        elsif patient['gender'] == 'F' && patient_breast_feeding?(patient['patient_id'], patient['last_dispense_date'])
+          report[patient['age_group']][patient[@param]][:breast_feeding] << @common_response
+          @condition = true
+          return
+        end
+
+        process_malawi_art_conditions report, patient
+      end
+
+      def process_malawi_art_conditions(report, patient)
+        %i[skin_rash nausea peripheral_neuropathy dizziness yellow_eyes].each do |condition|
+          method_name = :"patient_#{condition}?"
+          next unless send(method_name, patient['patient_id'], patient['last_dispense_date'])
+
+          report[patient['age_group']][patient[@param]][condition] << @common_response
+          @condition = true
+        end
+      end
+
+      def patient_new_on_art?(patient)
+        init_date = patient['earliest_start_date'].to_date
+        start_date = patient['start_date'].to_date
+
+        init_date + 6.months > start_date
+      end
+
+      def common_reponse(patient)
+        @common_response = if @param == 'tpt_type'
+                             { patient_id: patient['patient_id'], gender: patient['gender'] }
+                           else
+                             patient['patient_id']
+                           end
+      end
+
+      def tpt_drugs
+        ::ConceptName.where(name: ['INH', 'Isoniazid/Rifapentine', 'Rifapentine']).select(:concept_id)
+      end
+
+      def tpt_actual_drugs
+        @tpt_actual_drugs ||= ::Drug.where(concept_id: tpt_drugs.map(&:concept_id)).select(:drug_id).to_sql
+      end
+
+      def first_day_of_month
+        @first_day_of_month ||= ActiveRecord::Base.connection.quote((@start_date - 6.month).beginning_of_month)
+      end
+
+      def last_day_of_month
+        @last_day_of_month ||= ActiveRecord::Base.connection.quote((@start_date - 6.month).end_of_month)
+      end
+    end
+  end
+end

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

@@ -0,0 +1,169 @@
+# frozen_string_literal: true
+
+# This is MOH client returned to care report
+module MalawiHivProgramReports
+  module Clinic
+    class TxRtt
+      include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+
+      def initialize(start_date:, end_date:, **kwargs)
+        @start_date = ActiveRecord::Base.connection.quote(start_date)
+        @end_date = ActiveRecord::Base.connection.quote(end_date)
+        @occupation = kwargs[:occupation]
+      end
+
+      def find_report
+        tx_rtt.each_with_object({}) do |patient, report|
+          age_group = report[patient['age_group']] || { 'M' => [], 'F' => [], 'Unknown' => [] }
+          age_group[patient['gender']&.first&.upcase || 'Unknown'] << { patient_id: patient['patient_id'],
+                                                                        months: patient['months'] }
+
+          report[patient['age_group']] = age_group
+        end
+      end
+
+      private
+
+      def tx_rtt
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT patient_program.patient_id,
+            disaggregated_age_group(person.birthdate, #{@end_date}) AS age_group,
+            person.gender,
+            IF(
+              patient_state_at_start_of_quarter.state = 6, 'Treatment stopped',
+              IF(
+                patient_state_at_start_of_quarter.state = 12, 'Defaulted',
+                patient_outcome(patient_program.patient_id, (DATE(#{@start_date}) - INTERVAL 1 DAY) )
+              )
+            ) AS initial_outcome,
+            IF(
+              patient_state_at_start_of_quarter.state = 6,
+              patient_state_at_start_of_quarter.start_date,
+              IF(
+                patient_state_at_start_of_quarter.state = 12,
+                patient_state_at_start_of_quarter.start_date,
+                current_defaulter_date(patient_program.patient_id, (DATE(#{@start_date}) - INTERVAL 1 DAY) ))) AS initial_outcome_date,
+              IF(
+                patients_with_orders_at_end_of_quarter.patient_id IS NOT NULL,  'On antiretrovirals',
+                IF(
+                  current_defaulter(patient_program.patient_id, #{@end_date}) = 0,
+                  'On antiretrovirals','Defaulted'
+              )
+            ) AS final_outcome,
+            TIMESTAMPDIFF(MONTH, IF(
+              patient_state_at_start_of_quarter.state = 6,
+              patient_state_at_start_of_quarter.start_date,
+              IF(
+                patient_state_at_start_of_quarter.state = 12,
+                patient_state_at_start_of_quarter.start_date,
+                current_defaulter_date(
+                  patient_program.patient_id,
+                  (DATE(#{@start_date}) - INTERVAL 1 DAY)
+                )
+              )
+            ), patients_who_received_art_in_quarter.start_date) AS months
+          FROM patient_program
+          INNER JOIN person ON person.person_id = patient_program.patient_id
+          /* Select patients that were on treatment before start of reporting period */
+          INNER JOIN patient_state AS patient_ever_on_treatment
+            ON patient_ever_on_treatment.patient_program_id = patient_program.patient_program_id
+            AND patient_ever_on_treatment.state = 7
+            AND patient_ever_on_treatment.start_date < DATE(#{@start_date})
+            AND patient_ever_on_treatment.voided = 0
+          /* Get patient's state at the start of the quarter. */
+          INNER JOIN (
+            SELECT patient_program_id, MAX(patient_state.date_created) AS date_created
+            FROM patient_state
+            INNER JOIN patient_program USING (patient_program_id)
+            WHERE patient_state.voided = 0
+              AND patient_program.voided = 0
+              AND patient_program.program_id = 1
+              AND patient_state.start_date < DATE(#{@start_date}) + INTERVAL 1 DAY
+            GROUP BY patient_program_id
+          ) AS date_of_last_patient_state_before_quarter
+            ON date_of_last_patient_state_before_quarter.patient_program_id = patient_program.patient_program_id
+          LEFT JOIN patient_state AS patient_state_at_start_of_quarter
+            ON patient_state_at_start_of_quarter.patient_program_id = date_of_last_patient_state_before_quarter.patient_program_id
+            AND patient_state_at_start_of_quarter.date_created = date_of_last_patient_state_before_quarter.date_created
+            AND patient_state_at_start_of_quarter.state IN (6, 12) /* 2: TO, 6: Tx Stopped, 12: Defaulted */
+          /* Select patients who received ART within the reporting period. */
+          INNER JOIN (
+            SELECT DISTINCT encounter.patient_id, orders.start_date
+            FROM encounter
+            INNER JOIN orders
+              ON orders.encounter_id = encounter.encounter_id
+              AND DATE(orders.start_date) BETWEEN DATE(#{@start_date}) AND DATE(#{@end_date})
+              AND orders.voided = 0
+            INNER JOIN drug_order
+              ON drug_order.order_id = orders.order_id
+              AND drug_order.quantity > 0
+              AND drug_order.drug_inventory_id IN (SELECT DISTINCT drug_id FROM arv_drug)
+            WHERE encounter.voided = 0
+              AND encounter.program_id = 1
+              AND DATE(encounter.encounter_datetime) BETWEEN DATE(#{@start_date}) AND DATE(#{@end_date})
+          ) AS patients_who_received_art_in_quarter
+            ON patients_who_received_art_in_quarter.patient_id = patient_program.patient_id
+          /* Ensure that patients are on ART at the end of the quarter */
+          INNER JOIN (
+            SELECT patient_program_id, MAX(patient_state.date_created) AS date_created
+            FROM patient_state
+            INNER JOIN patient_program USING (patient_program_id)
+            WHERE patient_state.voided = 0
+              AND patient_program.voided = 0
+              AND patient_program.program_id = 1
+              AND patient_state.start_date < DATE(#{@end_date}) + INTERVAL 1 DAY
+            GROUP BY patient_program_id
+          ) AS date_of_last_patient_state_in_quarter
+            ON date_of_last_patient_state_in_quarter.patient_program_id = patient_program.patient_program_id
+
+            /*Not sure why Walter had this section in but I believe its not neccessary*/
+            /*INNER JOIN patient_state AS patient_state_at_end_of_quarter
+            ON patient_state_at_end_of_quarter.patient_program_id = patient_program.patient_program_id
+            AND patient_state_at_end_of_quarter.date_created = date_of_last_patient_state_before_quarter.date_created
+            AND patient_state_at_end_of_quarter.state = 7*/
+
+          /* Select patient who had orders in the last 30 days of the reporting period.
+             This is to be used as a quick filter for patients who are definitely
+             'On ART' by the end of the reporting period. The rest will be filtered by
+             the current_defaulter function. */
+          LEFT JOIN (
+            SELECT DISTINCT encounter.patient_id
+            FROM encounter
+            INNER JOIN orders
+              ON orders.encounter_id = encounter.encounter_id
+              AND orders.voided = 0
+              AND DATE(orders.start_date) BETWEEN DATE(#{@start_date}) AND DATE(#{@end_date})
+              AND orders.auto_expire_date >= (DATE(#{@end_date}) - INTERVAL 60 DAY)
+            INNER JOIN drug_order
+              ON drug_order.order_id = orders.order_id
+              AND drug_order.quantity > 0
+              AND drug_order.drug_inventory_id IN (SELECT DISTINCT drug_id FROM arv_drug)
+            WHERE encounter.program_id = 1
+              AND DATE(encounter.encounter_datetime) BETWEEN DATE(#{@start_date}) AND DATE(#{@end_date})
+              AND encounter.voided = 0
+          ) AS patients_with_orders_at_end_of_quarter
+            ON patients_with_orders_at_end_of_quarter.patient_id = patient_program.patient_id
+          LEFT JOIN (#{current_occupation_query}) AS a ON a.person_id = patient_program.patient_id
+          WHERE patient_program.program_id = 1
+            /* Ensure that the patients retrieved, did not receive ART within 28 days
+               before the start of the reporting period */
+            AND patient_program.patient_id NOT IN (
+              SELECT DISTINCT orders.patient_id
+              FROM orders
+              INNER JOIN drug_order USING (order_id)
+              INNER JOIN arv_drug ON arv_drug.drug_id = drug_inventory_id
+              INNER JOIN patient_program
+                ON patient_program.patient_id = orders.patient_id
+                AND patient_program.program_id = 1
+              WHERE ((DATE(orders.start_date) BETWEEN (DATE(#{@start_date}) - INTERVAL 60 DAY) AND DATE(#{@start_date}))
+                     OR (DATE(orders.auto_expire_date )BETWEEN (DATE(#{@start_date}) - INTERVAL 60 DAY) AND DATE(#{@start_date})))
+                AND orders.voided = 0
+            ) #{%w[Military Civilian].include?(@occupation) ? 'AND' : ''} #{occupation_filter(occupation: @occupation, field_name: 'value', table_name: 'a', include_clause: false)}
+          GROUP BY patient_program.patient_id
+          HAVING initial_outcome IN ('Defaulted', 'Treatment stopped')
+             AND final_outcome = 'On antiretrovirals';
+        SQL
+      end
+    end
+  end
+end