malawi_hiv_program_reports 1.0.1 → 1.0.3

data/app/services/malawi_hiv_program_reports/moh/cohort_builder.rb

@@ -0,0 +1,2337 @@
+# frozen_string_literal: true
+
+require_relative '../cohort/tpt'
+
+module MalawiHivProgramReports
+  module Moh
+    # This is the Cohort Builder class
+    # rubocop:disable Metrics/ClassLength
+    class CohortBuilder
+      QUARTER_LENGTH = 3.months
+
+      include MalawiHivProgramReports::Utils::ModelUtils
+      include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+      include MalawiHivProgramReports::Adapters::Moh::Custom
+
+      def initialize(outcomes_definition: 'moh', **kwargs)
+        unless %w[moh pepfar].include?(outcomes_definition.downcase)
+          raise ::ArgumentError, "Invalid outcomes_definition `#{outcomes_definition}` expected moh or pepfar"
+        end
+
+        @location = kwargs[:location]
+        @adapter = ActiveRecord::Base.connection.adapter_name.downcase
+        @outcomes_definition = outcomes_definition
+      end
+
+      def init_temporary_tables(_start_date, end_date, occupation)
+        create_temp_cohort_members_table
+        create_tmp_patient_table
+        drop_temp_register_start_date_table
+        drop_temp_other_patient_types
+        drop_temp_order_details
+        create_temp_other_patient_types(end_date)
+        create_temp_register_start_date_table(end_date)
+        create_temp_order_details(end_date)
+        load_data_into_temp_earliest_start_date(end_date.to_date, occupation)
+        update_cum_outcome(end_date)
+      end
+
+      def build(cohort_struct, start_date, end_date, occupation)
+        # load_tmp_patient_table(cohort_struct)
+        create_temp_cohort_members_table
+        create_tmp_patient_table
+        drop_temp_register_start_date_table
+        drop_temp_other_patient_types
+        drop_temp_order_details
+        create_temp_other_patient_types(end_date)
+        create_temp_register_start_date_table(end_date)
+        create_temp_order_details(end_date)
+        load_data_into_temp_earliest_start_date(end_date.to_date, occupation)
+
+        # create_tmp_patient_table_2(end_date)
+
+        time_started = Time.now.strftime('%Y-%m-%d %H:%M:%S')
+
+        # create_temp_earliest_start_date_table(end_date)
+        quarter_start_date = start_date.to_date
+
+        # Get earliest date enrolled
+        cum_start_date = get_cum_start_date
+
+        cum_start_date = start_date if cum_start_date.blank?
+
+        # Total registeres
+        cohort_struct.total_registered = total_registered(start_date, end_date)
+        cohort_struct.cum_total_registered = total_registered(cum_start_date, end_date)
+        cohort_struct.quarterly_total_registered = total_registered(quarter_start_date, end_date)
+
+        # Patients initiated on ART first time
+        cohort_struct.initiated_on_art_first_time = initiated_on_art_first_time(start_date, end_date)
+        cohort_struct.cum_initiated_on_art_first_time = initiated_on_art_first_time(cum_start_date, end_date)
+        cohort_struct.quarterly_initiated_on_art_first_time = initiated_on_art_first_time(quarter_start_date, end_date)
+
+        cohort_struct.males_initiated_on_art_first_time = males_initiated_on_art_first_time(start_date, end_date,
+                                                                                            cohort_struct.initiated_on_art_first_time)
+        cohort_struct.cum_males_initiated_on_art_first_time = males_initiated_on_art_first_time(cum_start_date,
+                                                                                                end_date, cohort_struct.cum_initiated_on_art_first_time)
+
+        # Patients re-initiated on ART
+        cohort_struct.re_initiated_on_art = re_initiated_on_art(start_date, end_date)
+        cohort_struct.cum_re_initiated_on_art = re_initiated_on_art(cum_start_date, end_date)
+        cohort_struct.quarterly_re_initiated_on_art = re_initiated_on_art(quarter_start_date, end_date)
+
+        # Patients transferred in on ART
+        cohort_struct.transfer_in = transfer_in(start_date, end_date, cohort_struct.re_initiated_on_art)
+        cohort_struct.cum_transfer_in = transfer_in(cum_start_date, end_date, cohort_struct.cum_re_initiated_on_art)
+        cohort_struct.quarterly_transfer_in = transfer_in(quarter_start_date, end_date,
+                                                          cohort_struct.quarterly_re_initiated_on_art)
+
+        # All males
+        cohort_struct.all_males = males(start_date, end_date)
+        cohort_struct.cum_all_males = males(cum_start_date, end_date)
+        cohort_struct.quarterly_all_males = males(quarter_start_date, end_date)
+
+        # Pregnant females (all ages)
+        cohort_struct.pregnant_females_all_ages = pregnant_females_all_ages(start_date, end_date)
+        cohort_struct.cum_pregnant_females_all_ages = pregnant_females_all_ages(cum_start_date, end_date)
+        cohort_struct.quarterly_pregnant_females_all_ages = pregnant_females_all_ages(quarter_start_date, end_date)
+
+        cohort_struct.initial_pregnant_females_all_ages = initial_females_all_ages(start_date, end_date,
+                                                                                   cohort_struct.pregnant_females_all_ages)
+        cohort_struct.cum_initial_pregnant_females_all_ages = initial_females_all_ages(cum_start_date, end_date,
+                                                                                       cohort_struct.cum_pregnant_females_all_ages)
+
+        # Non-pregnant females (all ages)
+        # Unique PatientProgram entries at the current location for those patients with at least one state ON ARVs
+        # and earliest start date of the 'ON ARVs' state within the quarter and having gender of
+        # related PERSON entry as F for female and no entries of 'IS PATIENT PREGNANT?' observation answered 'YES'
+        # in related HIV CLINIC CONSULTATION encounters not within 28 days from earliest registration date
+        cohort_struct.non_pregnant_females = non_pregnant_females(start_date, end_date,
+                                                                  cohort_struct.pregnant_females_all_ages)
+        cohort_struct.cum_non_pregnant_females = non_pregnant_females(cum_start_date, end_date,
+                                                                      cohort_struct.cum_pregnant_females_all_ages)
+        cohort_struct.quarterly_non_pregnant_females = non_pregnant_females(quarter_start_date, end_date,
+                                                                            cohort_struct.cum_pregnant_females_all_ages)
+
+        cohort_struct.initial_non_pregnant_females_all_ages = initial_females_all_ages(start_date, end_date, cohort_struct.non_pregnant_females.map do |a|
+                                                                                                               a['patient_id']
+                                                                                                             end)
+        cohort_struct.cum_initial_non_pregnant_females_all_ages = initial_females_all_ages(cum_start_date, end_date, cohort_struct.cum_non_pregnant_females.map do |a|
+                                                                                                                       a['patient_id']
+                                                                                                                     end)
+
+        # Children below 24 months at ART initiation
+        cohort_struct.children_below_24_months_at_art_initiation = children_below_24_months_at_art_initiation(
+          start_date, end_date
+        )
+        cohort_struct.cum_children_below_24_months_at_art_initiation = children_below_24_months_at_art_initiation(
+          cum_start_date, end_date
+        )
+        cohort_struct.quarterly_children_below_24_months_at_art_initiation = children_below_24_months_at_art_initiation(
+          quarter_start_date, end_date
+        )
+
+        # Children 24 months – 14 years at ART initiation
+        cohort_struct.children_24_months_14_years_at_art_initiation = children_24_months_14_years_at_art_initiation(
+          start_date, end_date
+        )
+        cohort_struct.cum_children_24_months_14_years_at_art_initiation = children_24_months_14_years_at_art_initiation(
+          cum_start_date, end_date
+        )
+        cohort_struct.quarterly_children_24_months_14_years_at_art_initiation = children_24_months_14_years_at_art_initiation(
+          quarter_start_date, end_date
+        )
+
+        # Adults at ART initiation
+        cohort_struct.adults_at_art_initiation = adults_at_art_initiation(start_date, end_date)
+        cohort_struct.cum_adults_at_art_initiation = adults_at_art_initiation(cum_start_date, end_date)
+        cohort_struct.quarterly_adults_at_art_initiation = adults_at_art_initiation(quarter_start_date, end_date)
+
+        # Unknown age
+        cohort_struct.unknown_age = unknown_age(start_date, end_date)
+        cohort_struct.cum_unknown_age = unknown_age(cum_start_date, end_date)
+        cohort_struct.quarterly_unknown_age = unknown_age(quarter_start_date, end_date)
+
+        # Unknown gender
+        cohort_struct.unknown_gender = unknown_gender(start_date, end_date)
+        cohort_struct.cum_unknown_gender = unknown_gender(cum_start_date, end_date)
+
+        # Unique PatientProgram entries at the current location for those
+        # patients with at least one state ON ARVs and earliest start date
+        # of the 'ON ARVs' state within the quarter and having a
+        # REASON FOR ELIGIBILITY observation with an answer as PRESUMED SEVERE HIV
+        cohort_struct.presumed_severe_hiv_disease_in_infants = presumed_severe_hiv_disease_in_infants(start_date,
+                                                                                                      end_date)
+        cohort_struct.cum_presumed_severe_hiv_disease_in_infants = presumed_severe_hiv_disease_in_infants(
+          cum_start_date, end_date
+        )
+        cohort_struct.quarterly_presumed_severe_hiv_disease_in_infants = presumed_severe_hiv_disease_in_infants(
+          quarter_start_date, end_date
+        )
+
+        # Confirmed HIV infection in infants (PCR)
+
+        # Unique PatientProgram entries at the current location for those patients with at least one state ON ARVs
+        # and earliest start date of the 'ON ARVs' state within the quarter and
+        # having a REASON FOR ELIGIBILITY observation with an answer as HIV PCR
+        cohort_struct.confirmed_hiv_infection_in_infants_pcr = confirmed_hiv_infection_in_infants_pcr(start_date,
+                                                                                                      end_date)
+        cohort_struct.cum_confirmed_hiv_infection_in_infants_pcr = confirmed_hiv_infection_in_infants_pcr(
+          cum_start_date, end_date
+        )
+        cohort_struct.quarterly_confirmed_hiv_infection_in_infants_pcr = confirmed_hiv_infection_in_infants_pcr(
+          quarter_start_date, end_date
+        )
+
+        # WHO stage 1 or 2, CD4 below threshold
+        # Unique PatientProgram entries at the current location for those patients with at least one state ON ARVs
+        # and earliest start date of the 'ON ARVs' state within the quarter and having a REASON FOR ELIGIBILITY
+        # observation with an answer as CD4 COUNT LESS THAN OR EQUAL TO 350 or CD4 COUNT LESS THAN OR EQUAL TO 750
+        cohort_struct.who_stage_two = who_stage_two(start_date, end_date)
+        cohort_struct.cum_who_stage_two = who_stage_two(cum_start_date, end_date)
+        cohort_struct.quarterly_who_stage_two = who_stage_two(quarter_start_date, end_date)
+
+        # Breastfeeding mothers
+
+        # Unique PatientProgram entries at the current location for those patients with at least one state
+        # ON ARVs and earliest start date of the 'ON ARVs' state within the quarter
+        # and having a REASON FOR ELIGIBILITY observation with an answer as BREASTFEEDING
+        cohort_struct.breastfeeding_mothers = breastfeeding_mothers(start_date, end_date)
+        cohort_struct.cum_breastfeeding_mothers = breastfeeding_mothers(cum_start_date, end_date)
+        cohort_struct.quarterly_breastfeeding_mothers = breastfeeding_mothers(quarter_start_date, end_date)
+
+        # Pregnant women
+
+        # Unique PatientProgram entries at the current location for those patients with at least one state ON ARVs
+        # and earliest start date of the 'ON ARVs' state within the quarter
+        # and having a REASON FOR ELIGIBILITY observation with an answer as PATIENT PREGNANT
+        cohort_struct.pregnant_women = pregnant_women(start_date, end_date)
+        cohort_struct.cum_pregnant_women = pregnant_women(cum_start_date, end_date)
+        cohort_struct.quarterly_pregnant_women = pregnant_women(quarter_start_date, end_date)
+
+        # WHO STAGE 3
+        # Unique PatientProgram entries at the current location for those patients with at least
+        # one state ON ARVs and earliest start date of the 'ON ARVs' state within the quarter
+        # and having a REASON FOR ELIGIBILITY observation with an answer as WHO STAGE III
+        cohort_struct.who_stage_three = who_stage_three(start_date, end_date)
+        cohort_struct.cum_who_stage_three = who_stage_three(cum_start_date, end_date)
+        cohort_struct.quarterly_who_stage_three = who_stage_three(quarter_start_date, end_date)
+
+        # WHO STAGE 4
+        # Unique PatientProgram entries at the current location for those patients with at least
+        # one state ON ARVs and earliest start date of the 'ON ARVs' state within the quarter
+        # and having a REASON FOR ELIGIBILITY observation with an answer as WHO STAGE IV
+        cohort_struct.who_stage_four = who_stage_four(start_date, end_date)
+        cohort_struct.cum_who_stage_four = who_stage_four(cum_start_date, end_date)
+        cohort_struct.quarterly_who_stage_four = who_stage_four(quarter_start_date, end_date)
+
+        # Asymptomatic
+        # Unique PatientProgram entries at the current location for those patients with at least
+        # one state ON ARVs and earliest start date of the 'ON ARVs' state within the quarter
+        # and having a REASON FOR ELIGIBILITY observation with an answer as Lymphocytes
+        # or LYMPHOCYTE COUNT BELOW THRESHOLD WITH WHO STAGE 2
+
+        # For all those patients with WHO stage 1 and 2, only those that were enrolled
+        # after or on 2016-04-01 revised_guidelines_start_date = "2016-04-01"
+        cohort_struct.asymptomatic = asymptomatic(start_date, end_date)
+        cohort_struct.cum_asymptomatic = asymptomatic(cum_start_date, end_date)
+        cohort_struct.quarterly_asymptomatic = asymptomatic(quarter_start_date, end_date)
+
+        # Unknown / other reason outside guidelines
+        # Unique PatientProgram entries at the current location for those patients with at least one state ON ARVs
+        # and earliest start date of the 'ON ARVs' state within the quarter
+        # and having a REASON FOR ELIGIBILITY observation with an answer as UNKNOWN
+        cohort_struct.unknown_other_reason_outside_guidelines = unknown_other_reason_outside_guidelines(start_date,
+                                                                                                        end_date)
+        cohort_struct.cum_unknown_other_reason_outside_guidelines = unknown_other_reason_outside_guidelines(
+          cum_start_date, end_date
+        )
+        cohort_struct.quarterly_unknown_other_reason_outside_guidelines = unknown_other_reason_outside_guidelines(
+          quarter_start_date, end_date
+        )
+
+        # Children 12-23 months
+
+        # Unique PatientProgram entries at the current location for those patients with at least one state
+        # ON ARVs and earliest start date of the 'ON ARVs' state within the quarter and having
+        # Confirmed HIV Infection (HIV Rapid antibody test or DNA-PCR), regardless of WHO stage and CD4 Count
+        cohort_struct.children_12_59_months = children_12_59_months(start_date, end_date)
+        cohort_struct.cum_children_12_59_months = children_12_59_months(cum_start_date, end_date)
+        cohort_struct.quarterly_children_12_59_months = children_12_59_months(quarter_start_date, end_date)
+
+        # Current EPISODE OF TB
+
+        # Unique PatientProgram entries at the current location for those patients with at least one state
+        # ON ARVs and earliest start date of the 'ON ARVs' state within the quarter and having a
+        # CURRENT EPISODE OF TB observation at the HIV staging encounter on the initiation date
+        cohort_struct.current_episode_of_tb = current_episode_of_tb(start_date, end_date)
+        cohort_struct.cum_current_episode_of_tb = current_episode_of_tb(cum_start_date, end_date)
+        cohort_struct.quarterly_current_episode_of_tb = current_episode_of_tb(quarter_start_date, end_date)
+
+        # TB within the last 2 years
+
+        # Unique PatientProgram entries at the current location for those patients with at least one state ON ARVs
+        # and earliest start date of the 'ON ARVs' state within the quarter
+        # and having a TB WITHIN THE LAST 2 YEARS observation at the HIV staging encounter on the initiation date
+        cohort_struct.tb_within_the_last_two_years = tb_within_the_last_two_years(cohort_struct.current_episode_of_tb,
+                                                                                  start_date, end_date)
+        cohort_struct.cum_tb_within_the_last_two_years = tb_within_the_last_two_years(
+          cohort_struct.cum_current_episode_of_tb, cum_start_date, end_date
+        )
+        cohort_struct.quarterly_tb_within_the_last_two_years = tb_within_the_last_two_years(
+          cohort_struct.quarterly_current_episode_of_tb, quarter_start_date, end_date
+        )
+
+        # No TB
+        # total_registered - (current_episode - tb_within_the_last_two_years)
+        cohort_struct.no_tb = no_tb(cohort_struct.total_registered, cohort_struct.tb_within_the_last_two_years,
+                                    cohort_struct.current_episode_of_tb)
+        cohort_struct.cum_no_tb = cum_no_tb(cohort_struct.cum_total_registered,
+                                            cohort_struct.cum_tb_within_the_last_two_years, cohort_struct.cum_current_episode_of_tb)
+        cohort_struct.quarterly_no_tb = cum_no_tb(cohort_struct.quarterly_total_registered,
+                                                  cohort_struct.quarterly_tb_within_the_last_two_years, cohort_struct.quarterly_current_episode_of_tb)
+
+        # Kaposis Sarcoma
+        #
+        # Unique PatientProgram entries at the current location for those patients with at least one state ON ARVs
+        # and earliest start date of the 'ON ARVs' state within the quarter and having a KAPOSIS SARCOMA observation
+        # at the HIV staging encounter on the initiation date
+        cohort_struct.kaposis_sarcoma = kaposis_sarcoma(start_date, end_date)
+        cohort_struct.cum_kaposis_sarcoma = kaposis_sarcoma(cum_start_date, end_date)
+        cohort_struct.quarterly_kaposis_sarcoma = kaposis_sarcoma(quarter_start_date, end_date)
+
+        # From this point going down: we update temp_earliest_start_date cum_outcome field to have the latest Cumulative outcome
+        update_cum_outcome(end_date)
+        update_tb_status(end_date)
+        update_patient_side_effects(end_date)
+
+        # Total Alive and On ART
+        # Unique PatientProgram entries at the current location for those patients with at least one state
+        # ON ARVs and earliest start date of the 'ON ARVs' state less than or equal to end date of quarter
+        # and latest state is ON ARVs  (Excluding defaulters)
+        cohort_struct.total_alive_and_on_art                      = get_outcome('On antiretrovirals')
+        cohort_struct.died_within_the_1st_month_of_art_initiation = died_in('1st month')
+        cohort_struct.died_within_the_2nd_month_of_art_initiation = died_in('2nd month')
+        cohort_struct.died_within_the_3rd_month_of_art_initiation = died_in('3rd month')
+        cohort_struct.died_after_the_3rd_month_of_art_initiation  = died_in('4+ months')
+        cohort_struct.died_total                                  = get_outcome('Patient died')
+        cohort_struct.defaulted                                   = get_outcome('Defaulted')
+        cohort_struct.stopped_art                                 = get_outcome('Treatment stopped')
+        cohort_struct.transfered_out                              = get_outcome('Patient transferred out')
+        cohort_struct.unknown_outcome                             = get_outcome('Pre-ART (Continue)')
+
+        # ARV Regimen category
+        # Alive and On ART and Value Coded of the latest 'Regimen Category' Observation
+        # of each patient that is linked to the Dispensing encounter in the reporting period
+
+        prescriptions = cal_regimem_category(cohort_struct.total_alive_and_on_art, end_date)
+
+        # concepts = ->(names) { ::ConceptName.where(name: names).select(:concept_id) }
+        # drugs = ->(concepts) { ::Drug.where(concept: concepts).select(:drug_id).collect(&:drug_id) }
+
+        # lpv_granules = drugs[concepts[['LPV/r Pellets', 'LPV/r Granules']]]
+        # lpv_tabs = drugs[concepts['LPV/r']]
+
+        cohort_struct.zero_p            = filter_prescriptions_by_regimen(prescriptions, '0P')
+        cohort_struct.zero_a            = filter_prescriptions_by_regimen(prescriptions, '0A')
+        cohort_struct.two_p             = filter_prescriptions_by_regimen(prescriptions, '2P')
+        cohort_struct.two_a             = filter_prescriptions_by_regimen(prescriptions, '2A')
+        cohort_struct.four_a            = filter_prescriptions_by_regimen(prescriptions, '4A')
+        cohort_struct.four_pp           = filter_prescriptions_by_regimen(prescriptions, '4PP')
+        cohort_struct.four_pa           = filter_prescriptions_by_regimen(prescriptions, '4PA')
+        cohort_struct.five_a            = filter_prescriptions_by_regimen(prescriptions, '5A')
+        cohort_struct.six_a             = filter_prescriptions_by_regimen(prescriptions, '6A')
+        cohort_struct.seven_a           = filter_prescriptions_by_regimen(prescriptions, '7A')
+        cohort_struct.eight_a           = filter_prescriptions_by_regimen(prescriptions, '8A')
+        cohort_struct.nine_a            = filter_prescriptions_by_regimen(prescriptions, '9A')
+        cohort_struct.nine_pp           = filter_prescriptions_by_regimen(prescriptions, '9PP')
+        cohort_struct.nine_pa           = filter_prescriptions_by_regimen(prescriptions, '9PA')
+        cohort_struct.ten_a             = filter_prescriptions_by_regimen(prescriptions, '10A')
+        cohort_struct.eleven_a          = filter_prescriptions_by_regimen(prescriptions, '11A')
+        cohort_struct.eleven_pp         = filter_prescriptions_by_regimen(prescriptions, '11PP')
+        cohort_struct.eleven_pa         = filter_prescriptions_by_regimen(prescriptions, '11PA')
+        cohort_struct.twelve_a          = filter_prescriptions_by_regimen(prescriptions, '12A')
+        cohort_struct.twelve_pp         = filter_prescriptions_by_regimen(prescriptions, '12PP')
+        cohort_struct.twelve_pa         = filter_prescriptions_by_regimen(prescriptions, '12PA')
+        cohort_struct.thirteen_a        = filter_prescriptions_by_regimen(prescriptions, '13A')
+        cohort_struct.fourteen_pp       = filter_prescriptions_by_regimen(prescriptions, '14PP')
+        cohort_struct.fourteen_pa       = filter_prescriptions_by_regimen(prescriptions, '14PA')
+        cohort_struct.fourteen_a        = filter_prescriptions_by_regimen(prescriptions, '14A')
+        cohort_struct.fifteen_pp        = filter_prescriptions_by_regimen(prescriptions, '15PP')
+        cohort_struct.fifteen_pa        = filter_prescriptions_by_regimen(prescriptions, '15PA')
+        cohort_struct.fifteen_a         = filter_prescriptions_by_regimen(prescriptions, '15A')
+        cohort_struct.sixteen_p         = filter_prescriptions_by_regimen(prescriptions, '16P')
+        cohort_struct.sixteen_a         = filter_prescriptions_by_regimen(prescriptions, '16A')
+        cohort_struct.seventeen_pp      = filter_prescriptions_by_regimen(prescriptions, '17PP')
+        cohort_struct.seventeen_pa      = filter_prescriptions_by_regimen(prescriptions, '17PA')
+        cohort_struct.seventeen_a       = filter_prescriptions_by_regimen(prescriptions, '17A')
+        cohort_struct.unknown_regimen   = filter_prescriptions_by_regimen(prescriptions, 'unknown_regimen')
+
+        # Total patients with side effects:
+        # Alive and On ART patients with DRUG INDUCED observations during their last HIV CLINIC CONSULTATION encounter up to the reporting period
+
+        with_se, without_se, se_unknowns = patients_side_effects_status(cohort_struct.total_alive_and_on_art, end_date)
+        cohort_struct.total_patients_with_side_effects = with_se
+        cohort_struct.total_patients_without_side_effects = without_se
+        cohort_struct.unknown_side_effects = se_unknowns
+
+        # TB Status
+        # Alive and On ART with 'TB Status' observation value of 'TB not Suspected' or 'TB Suspected'
+        # or 'TB confirmed and on Treatment', or 'TB confirmed and not on Treatment' or 'Unknown TB status'
+        # during their latest HIV Clinic Consultaiton encounter in the reporting period
+        write_tb_status_indicators(cohort_struct, cohort_struct.total_alive_and_on_art, start_date, end_date)
+
+        # ART adherence
+        #
+        # Alive and On ART with value of their 'Drug order adherence" observation during their latest Adherence
+        # encounter in the reporting period  between 95 and 105
+        adherent, not_adherent, unknown_adherence = latest_art_adherence(cohort_struct.total_alive_and_on_art,
+                                                                         start_date, end_date)
+        cohort_struct.patients_with_0_6_doses_missed_at_their_last_visit = adherent
+        cohort_struct.patients_with_7_plus_doses_missed_at_their_last_visit = not_adherent
+        cohort_struct.patients_with_unknown_adhrence = unknown_adherence
+
+        # Pregnant and breastfeeding status during Consultaiton
+        cohort_struct.total_pregnant_women = total_pregnant_women(cohort_struct.total_alive_and_on_art, start_date,
+                                                                  end_date)
+        cohort_struct.total_breastfeeding_women = total_breastfeeding_women(cohort_struct.total_alive_and_on_art,
+                                                                            cohort_struct.total_pregnant_women, start_date, end_date)
+        cohort_struct.total_other_patients = total_other_patients(cohort_struct.total_alive_and_on_art,
+                                                                  cohort_struct.total_breastfeeding_women, cohort_struct.total_pregnant_women)
+
+        # Patients with CPT dispensed at least once before end of quarter and on ARVs
+        cohort_struct.total_patients_on_arvs_and_cpt = total_patients_on_arvs_and_cpt(
+          cohort_struct.total_alive_and_on_art, start_date, end_date
+        )
+
+        # Patients with IPT dispensed at least once before end of quarter and on ARVS
+        cohort_struct.total_patients_on_arvs_and_ipt = total_patients_on_arvs_and_ipt(
+          cohort_struct.total_alive_and_on_art, start_date, end_date
+        )
+
+        # Patients on family planning methods at least once before end of quarter and on ARVs
+        cohort_struct.total_patients_on_family_planning = total_patients_on_family_planning(
+          cohort_struct.total_alive_and_on_art, quarter_start_date, end_date
+        )
+
+        # Patients whose BP was screened and are above 30 years least once before end of quarter and on ARVs
+        cohort_struct.total_patients_with_screened_bp = total_patients_with_screened_bp(
+          total_patients_alive_and_on_art_above_30_years(cohort_struct.total_alive_and_on_art,
+                                                         end_date), start_date, end_date
+        )
+
+        # Patients who started TPT in current reporting period
+        tpt = MalawiHivProgramReports::Cohort::Tpt.new(start_date:, end_date:, occupation:,
+                                                       location: @location)
+        # tpt newly initiated has a property last_tpt_start_date we need to use that to get those clients
+        cohort_struct.newly_initiated_on_3hp = tpt.newly_initiated_on_3hp.select do |hash|
+          hash['last_tpt_start_date'].nil?
+        end
+        cohort_struct.newly_initiated_on_ipt = tpt.newly_initiated_on_ipt.select do |hash|
+          hash['last_tpt_start_date'].nil?
+        end
+        time_ended = Time.now.strftime('%Y-%m-%d %H:%M:%S')
+        puts "Started at: #{time_started}. Finished at: #{time_ended}. Total time in minutes: #{(Time.parse(time_ended) - Time.parse(time_started)) / 60}"
+        Rails.logger.info "Started at: #{time_started}. Finished at: #{Time.now.strftime('%Y-%m-%d %H:%M:%S')}. Total time in minutes: #{(Time.parse(time_ended) - Time.parse(time_started)) / 60}"
+        cohort_struct
+      end
+
+      # private
+
+      def get_disaggregated_cohort(start_date, end_date, gender, ag)
+        case ag
+        when '50+ years'
+          diff = [50, 1000]
+          iu = 'year'
+        when /years/i
+          diff = ag.sub(' years', '').split('-')
+          iu = 'year'
+        when /months/i
+          diff = ag.sub(' months', '').split('-')
+          iu = 'month'
+        else
+          case gender
+          when 'M'
+            diff = [0, 1000]
+            iu = 'year'
+            gender = 'M'
+          when 'FNP'
+            diff = [0, 1000]
+            iu = 'year'
+            gender = 'F'
+          when 'FP'
+            diff = [0, 1000]
+            iu = 'year'
+            gender = 'F'
+          when 'FBf'
+            diff = [0, 1000]
+            iu = 'year'
+            gender = 'F'
+          end
+        end
+
+        data = ActiveRecord::Base.connection.select_all(
+          "SELECT patient_id  FROM temp_earliest_start_date
+           WHERE earliest_start_date BETWEEN '#{start_date.to_date}' AND '#{end_date.to_date}'
+            AND (earliest_start_date) = (date_enrolled) AND gender = '#{gender.first}' #{site_manager(operator: 'AND',
+                                                                                                      column: 'site_id', location: @location)}
+            AND timestampdiff(#{iu}, birthdate, date_enrolled) BETWEEN #{diff[0].to_i} AND #{diff[1].to_i}"
+        )
+
+        data1 = ActiveRecord::Base.connection.select_all(
+          "SELECT t1.patient_id
+          FROM temp_earliest_start_date t1
+          INNER JOIN temp_patient_outcomes t2 ON t1.patient_id = t2.patient_id #{site_manager(operator: 'AND',
+                                                                                              column: 't2.site_id', location: @location)}
+          WHERE date_enrolled <= '#{end_date.to_date}' AND gender = '#{gender.first}'
+            AND cum_outcome = 'On antiretrovirals' #{site_manager(operator: 'AND', column: 't1.site_id',
+                                                                  location: @location)}
+            AND timestampdiff(#{iu}, birthdate, date_enrolled) BETWEEN #{diff[0].to_i} AND #{diff[1].to_i}"
+        )
+
+        ::EncounterType.find_by_name('DISPENSING').id
+        amount_dispensed = concept('Amount dispensed').concept_id
+        ipt_drug_ids = ::Drug.find_all_by_concept_id(656).map(&:drug_id)
+
+        patient_ids = []
+        (data1 || {}).each_key do |x|
+          patient_ids << x['patient_id'].to_i
+        end
+
+        unless patient_ids.blank?
+          data2 = ActiveRecord::Base.connection.select_all(
+            "SELECT e.patient_id
+            FROM encounter e
+            INNER JOIN temp_patient_outcomes o ON o.patient_id = e.patient_id
+              AND o.cum_outcome = 'On antiretrovirals' #{site_manager(operator: 'AND', column: 'o.site_id',
+                                                                      location: @location)}
+            INNER JOIN obs ON obs.encounter_id = e.encounter_id
+              AND obs.concept_id = #{amount_dispensed} #{site_manager(operator: 'AND', column: 'obs.site_id',
+                                                                      location: @location)}
+            WHERE value_drug IN(#{ipt_drug_ids.join(',')})
+              AND e.patient_id IN(#{patient_ids.join(',')})
+              AND e.encounter_datetime BETWEEN '#{start_date.to_date.strftime('%Y-%m-%d 00:00:00')}'
+              AND '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}' #{site_manager(operator: 'AND',
+                                                                                     column: 'e.site_id', location: @location)}
+            GROUP BY e.patient_id"
+          )
+        end
+
+        [data&.length || 0, data1&.length || 0, data2.length || 0, 0]
+      end
+
+      def patient_with_missing_start_reasons(start_date, end_date)
+        art_patients = ActiveRecord::Base.connection.select_all(
+          "SELECT e.*, #{function_manager(function: 'patient_reason_for_starting_art_text', location: @location,
+                                          args: "e.patient_id, #{@location}")} reason
+          FROM temp_earliest_start_date e
+          WHERE date_enrolled BETWEEN '#{start_date.to_date}' AND '#{end_date.to_date}' #{site_manager(operator: 'AND',
+                                                                                                       column: 'e.site_id', location: @location)}"
+        )
+
+        data = {}
+        art_patients.each do |p|
+          patient = ::Patient.find(p['patient_id'].to_i)
+          reason_for_starting = p['reason']
+          next unless reason_for_starting.blank?
+
+          data[patient.patient_id] = {
+            arv_number: patient.arv_number,
+            earliest_start_date: (begin
+              p['earliest_start_date'].to_date
+            rescue StandardError
+              nil
+            end),
+            date_enrolled: (begin
+              p['date_enrolled'].to_date
+            rescue StandardError
+              nil
+            end),
+            name: patient.person.name,
+            gender: patient.person.gender,
+            birthdate: patient.person.birth_date,
+            outcome: p['outcome']
+          }
+        end
+
+        data
+      rescue StandardError
+        raise 'Try running the revised cohort before this report'
+      end
+
+      def on_art_patients_with_no_arvs_dispensations(start_date, end_date)
+        arv_drugs = MedicationService.arv_drugs
+        arv_drugs = arv_drugs.map(&:concept_id)
+
+        start_date.to_date
+        end_date.to_date
+
+        data = ActiveRecord::Base.connection.select_all(
+          "SELECT patient_id
+          FROM orders o
+          INNER JOIN drug_order drg ON drg.order_id = o.order_id #{site_manager(operator: 'AND', column: 'drg.site_id',
+                                                                                location: @location)}
+          AND o.voided = 0
+          WHERE drug_inventory_id IN(
+            SELECT drug_id FROM drug
+            WHERE concept_id IN(#{arv_drugs.join(',')})
+          ) #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+          GROUP BY patient_id"
+        )
+
+        patient_ids = data.map { |d| d['patient_id'].to_i }
+
+        begin
+          patients = ActiveRecord::Base.connection.select_all(
+            "SELECT * FROM temp_earliest_start_date WHERE patient_id NOT IN(#{patient_ids.join(',')}) #{site_manager(
+              operator: 'AND', column: 'site_id', location: @location
+            )}"
+          )
+        rescue StandardError
+          raise 'Try running the revised cohort before this report'
+        end
+
+        reason_for_starting = concept('REASON FOR ART ELIGIBILITY')
+        data = {}
+
+        (patients || []).each do |p|
+          patient = ::Patient.find(p['patient_id'].to_i)
+          reason_for_starting = ::PatientService.reason_for_art_eligibility(patient)
+          # next unless reason_for_starting.blank?
+
+          patient_obj = ::PatientService.get_patient(patient.person)
+          data[patient_obj.patient_id] = {
+            arv_number: patient_obj.arv_number,
+            earliest_start_date: p['earliest_start_date'],
+            date_enrolled: p['date_enrolled'].to_date,
+            name: patient_obj.name,
+            gender: patient_obj.sex,
+            birthdate: patient_obj.birth_date,
+            outcome: p['outcome']
+          }
+        end
+
+        data
+      end
+
+      def patients_with_pre_art_or_unknown_outcome(_start_date, _end_date)
+        begin
+          patients = ActiveRecord::Base.connection.select_all(
+            "SELECT e.*, cum_outcome, #{function_manager(function: 'patient_reason_for_starting_art_text',
+                                                         location: @location, args: "e.patient_id, #{@location}")} reason_for_starting
+            FROM temp_patient_outcomes o
+            INNER JOIN temp_earliest_start_date e ON e.patient_id = o.patient_id #{site_manager(operator: 'AND',
+                                                                                                column: 'e.site_id', location: @location)}
+            WHERE cum_outcome LIKE '%Pre-%' OR cum_outcome LIKE '%Unknown%' #{site_manager(operator: 'AND',
+                                                                                           column: 'o.site_id', location: @location)}"
+          )
+        rescue StandardError
+          raise 'Try running the revised cohort before this report'
+        end
+
+        data = {}
+
+        (patients || []).each do |p|
+          ::Patient.find(p['patient_id'].to_i)
+
+          patient_outcome = p['cum_outcome']
+          person = ::Person.find(p['patient_id'])
+
+          patient_obj = ::PatientService.get_patient(person)
+          data[patient_obj.patient_id] = {
+            arv_number: patient_obj.arv_number,
+            earliest_start_date: (begin
+              p['earliest_start_date'].to_date
+            rescue StandardError
+              nil
+            end),
+            date_enrolled: (begin
+              p['date_enrolled'].to_date
+            rescue StandardError
+              nil
+            end),
+            name: patient_obj.name,
+            gender: patient_obj.sex,
+            birthdate: patient_obj.birth_date,
+            reason_for_starting: p['reason_for_starting'],
+            outcome: patient_outcome['outcome']
+          }
+        end
+
+        data
+      end
+
+      STATE_DIED = 3
+      STATE_ON_TREATMENT = 7
+
+      def load_data_into_temp_earliest_start_date(end_date, occupation = nil)
+        load_data_into_temp_cohort_members_table(end_date)
+        ActiveRecord::Base.connection.execute <<~SQL
+          INSERT INTO temp_earliest_start_date
+          SELECT patient_id, site_id, date_enrolled, earliest_start_date, recorded_start_date, birthdate, birthdate_estimated, death_date, gender, age_at_initiation, age_in_days, reason_for_starting_art
+          FROM temp_cohort_members #{occupation_filter(occupation:, field_name: 'occupation')} #{site_manager(operator: min_filt(occupation).to_s, column: 'site_id', location: @location)}
+        SQL
+      end
+
+      # rubocop:disable Metrics/MethodLength
+      def load_data_into_temp_cohort_members_table(end_date)
+        end_date = ActiveRecord::Base.connection.quote(end_date)
+
+        type_of_patient_concept = concept('Type of patient').concept_id
+        new_patient_concept = concept('New patient').concept_id
+        drug_refill_concept = concept('Drug refill').concept_id
+        external_concept = concept('External Consultation').concept_id
+        program_id = program('HIV program').id
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          INSERT INTO temp_cohort_members
+          SELECT patient_program.patient_id, #{@location} as site_id,
+                 DATE(MIN(art_order.start_date)) AS date_enrolled,
+                 DATE(COALESCE(MIN(art_start_date_obs.value_datetime), MIN(art_order.start_date))) AS earliest_start_date,
+                 DATE(MIN(art_start_date_obs.value_datetime)) AS recorded_start_date,
+                 person.birthdate,
+                #{@adapter == 'mysql2' ? 'person.birthdate_estimated' : '(CASE WHEN person.birthdate_estimated = 0 THEN false ELSE true END)'} AS birthdate_estimated,
+                 person.death_date,
+                 person.gender, #{
+                   if @adapter == 'mysql2'
+                     <<~SQL
+                       IF(person.birthdate IS NOT NULL, TIMESTAMPDIFF(YEAR, person.birthdate,  DATE(COALESCE(art_start_date_obs.value_datetime, MIN(art_order.start_date)))), NULL) AS age_at_initiation,
+                       IF(person.birthdate IS NOT NULL, TIMESTAMPDIFF(DAY, person.birthdate,  DATE(COALESCE(art_start_date_obs.value_datetime, MIN(art_order.start_date)))), NULL) AS age_in_days,
+                     SQL
+                   else
+                     <<~SQL
+                       CASE
+                       WHEN person.birthdate IS NOT NULL THEN
+                           EXTRACT(YEAR FROM AGE(COALESCE(MIN(art_start_date_obs.value_datetime)::DATE, MIN(art_order.start_date)), person.birthdate))
+                       ELSE NULL
+                       END AS age_at_initiation,
+                       CASE
+                       WHEN person.birthdate IS NOT NULL THEN
+                           EXTRACT(DAY FROM AGE(COALESCE(MIN(art_start_date_obs.value_datetime)::DATE, MIN(art_order.start_date)), person.birthdate))
+                       ELSE NULL
+                       END AS age_in_days,
+                     SQL
+                   end
+                 }
+                 (SELECT value_coded FROM obs
+                  WHERE concept_id = 7563 AND person_id = patient_program.patient_id AND voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+                  ORDER BY obs_datetime DESC, date_created DESC LIMIT 1) as reason_for_starting_art,
+                 pa.value AS occupation
+          FROM patient_program
+          INNER JOIN person ON person.person_id = patient_program.patient_id #{site_manager(operator: 'AND', column: 'person.site_id', location: @location)}
+          LEFT JOIN (#{current_occupation_query}) pa ON pa.person_id = patient_program.patient_id #{site_manager(operator: 'AND', column: 'pa.site_id', location: @location)}
+          LEFT JOIN patient_state AS outcome
+            ON outcome.patient_program_id = patient_program.patient_program_id #{site_manager(operator: 'AND', column: 'outcome.site_id', location: @location)}
+          LEFT JOIN encounter AS clinic_registration_encounter
+            ON clinic_registration_encounter.encounter_type = (
+              SELECT encounter_type_id FROM encounter_type WHERE LOWER(name) = LOWER('HIV CLINIC REGISTRATION') LIMIT 1
+            )
+            AND clinic_registration_encounter.patient_id = patient_program.patient_id
+            AND clinic_registration_encounter.program_id = patient_program.program_id
+            AND clinic_registration_encounter.encounter_datetime < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')}
+            AND clinic_registration_encounter.voided = 0 #{site_manager(operator: 'AND', column: 'clinic_registration_encounter.site_id', location: @location)}
+          LEFT JOIN obs AS art_start_date_obs
+            ON art_start_date_obs.concept_id = 2516
+            AND art_start_date_obs.person_id = patient_program.patient_id
+            AND art_start_date_obs.voided = 0 #{site_manager(operator: 'AND', column: 'art_start_date_obs.site_id', location: @location)}
+            AND art_start_date_obs.obs_datetime < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')}
+            AND art_start_date_obs.encounter_id = clinic_registration_encounter.encounter_id
+           /* TODO: Re-enable the following condition. Has been removed because LLH and PIH
+              were noted to be dropping patients because of it. Seems these sites may have orders
+              without corresponding encounters. Adding this condition bumps up performance a bit. */
+           /* INNER JOIN encounter AS prescription_encounter
+            ON prescription_encounter.patient_id = patient_program.patient_id
+            AND prescription_encounter.program_id = patient_program.program_id
+            AND prescription_encounter.encounter_datetime < DATE(#{end_date}) + INTERVAL 1 DAY
+            AND prescription_encounter.encounter_type IN (SELECT encounter_type_id FROM encounter_type WHERE name LIKE 'Treatment')
+            AND prescription_encounter.voided = 0 */
+          LEFT JOIN temp_register_start_date AS patient_type_obs
+            ON patient_type_obs.patient_id = patient_program.patient_id #{site_manager(operator: 'AND', column: 'patient_type_obs.site_id', location: @location)}
+          /*INNER JOIN orders AS art_order
+            ON art_order.patient_id = patient_program.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 < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')}
+            AND art_order.order_type_id = #{order_type('Drug order').id}
+            AND art_order.start_date >= COALESCE(patient_type_obs.start_date, DATE('1901-01-01'))
+            AND art_order.voided = 0 #{site_manager(operator: 'AND', column: 'art_order.site_id', location: @location)}
+          INNER JOIN drug_order
+            ON drug_order.order_id = art_order.order_id
+            AND drug_order.quantity > 0 #{site_manager(operator: 'AND', column: 'drug_order.site_id', location: @location)} */
+          INNER JOIN temp_order_details AS art_order ON art_order.patient_id = patient_program.patient_id #{site_manager(operator: 'AND', column: 'art_order.site_id', location: @location)}
+          WHERE patient_program.voided = 0
+            AND outcome.voided = 0
+            AND patient_program.program_id = 1
+            AND outcome.state = 7
+            AND outcome.start_date IS NOT NULL #{site_manager(operator: 'AND', column: 'patient_program.site_id', location: @location)}
+            /*AND patient_program.patient_id NOT IN (
+              SELECT e.patient_id FROM encounter e
+              LEFT JOIN (SELECT * FROM obs WHERE concept_id = #{type_of_patient_concept} AND voided = 0 AND value_coded = #{new_patient_concept}) AS new_patient ON e.patient_id = new_patient.person_id
+              LEFT JOIN (SELECT * FROM obs WHERE concept_id = #{type_of_patient_concept} AND voided = 0 AND value_coded = #{drug_refill_concept}) AS refill ON e.patient_id = refill.person_id
+              LEFT JOIN (SELECT * FROM obs WHERE concept_id = #{type_of_patient_concept} AND voided = 0 AND value_coded = #{external_concept}) AS external ON e.patient_id = external.person_id
+              WHERE e.program_id = #{program_id} AND (refill.value_coded IS NOT NULL OR external.value_coded IS NOT NULL)
+              AND new_patient.value_coded IS NULL
+              AND e.encounter_datetime < DATE(#{end_date}) + INTERVAL 1 DAY
+              AND e.encounter_type IN (SELECT encounter_type_id FROM encounter_type WHERE name = 'REGISTRATION' AND retired = 0)
+              GROUP BY e.patient_id
+            )*/
+          GROUP by patient_program.patient_id #{@adapter == 'mysql2' ? '' : ',person.birthdate, person.birthdate_estimated, person.death_date, person.gender, pa.value'}
+          HAVING #{@adapter == 'mysql2' ? 'date_enrolled' : 'art_order.start_date'} <= #{end_date}
+        SQL
+        remove_drug_refills_and_external_consultation(end_date)
+      end
+      # rubocop:enable Metrics/MethodLength
+
+      ##
+      # This will hold crucial information for cohort members
+      # rubocop:disable Metrics/MethodLength
+      # rubocop:disable Metrics/AbcSize
+      def create_temp_cohort_members_table
+        ActiveRecord::Base.connection.execute('DROP TABLE IF EXISTS temp_cohort_members')
+        exe_temp_cohort_members_table(adapter: @adapter)
+
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_id_index ON temp_cohort_members (patient_id)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_site_index ON temp_cohort_members (site_id)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_id_site_index ON temp_cohort_members (patient_id, site_id)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_enrolled_index ON temp_cohort_members (date_enrolled)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_date_enrolled_index ON temp_cohort_members (patient_id, date_enrolled)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_start_date_index ON temp_cohort_members (earliest_start_date)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_start_date__date_enrolled_index ON temp_cohort_members (patient_id, earliest_start_date, date_enrolled, gender)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_reason ON temp_cohort_members (reason_for_starting_art)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_birthdate_idx ON temp_cohort_members (birthdate)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX member_occupation_idx ON temp_cohort_members (birthdate)'
+        )
+      end
+      # rubocop:enable Metrics/AbcSize
+      # rubocop:enable Metrics/MethodLength
+
+      def create_temp_other_patient_types(_end_date)
+        type_of_patient_concept = concept('Type of patient').concept_id
+        drug_refill_concept = concept('Drug refill').concept_id
+        external_concept = concept('External consultation').concept_id
+        exe_temp_other_patient_types(adapter: @adapter)
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          INSERT INTO temp_other_patient_types (patient_id, site_id)
+          SELECT pp.patient_id as patient_id, pp.site_id as site_id
+          FROM patient_program pp
+          INNER JOIN obs o ON pp.patient_id = o.person_id AND o.concept_id = #{type_of_patient_concept} #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+          AND #{in_manager(column: 'o.value_coded', values: [drug_refill_concept, external_concept])}
+          AND o.voided = 0
+          WHERE pp.program_id = 1
+          AND pp.voided = 0
+          #{site_manager(operator: 'AND', column: 'pp.site_id', location: @location)}
+          GROUP BY pp.patient_id #{@adapter == 'mysql2' ? '' : ', pp.site_id'}
+        SQL
+      end
+
+      def drop_temp_other_patient_types
+        ActiveRecord::Base.connection.execute <<~SQL
+          DROP TABLE IF EXISTS temp_other_patient_types
+        SQL
+      end
+
+      def drop_temp_order_details
+        ActiveRecord::Base.connection.execute <<~SQL
+          DROP TABLE IF EXISTS temp_order_details
+        SQL
+      end
+
+      def create_temp_order_details(end_date)
+        exe_temp_order_details_table(adapter: @adapter)
+        ActiveRecord::Base.connection.execute <<~SQL
+          INSERT INTO temp_order_details
+          SELECT o.patient_id, o.site_id, DATE(MIN(o.start_date)) start_date#{'  '}
+          FROM orders o
+          INNER JOIN drug_order do ON do.order_id = o.order_id AND do.quantity > 0 #{site_manager(operator: 'AND', column: 'do.site_id', location: @location)}
+          LEFT JOIN temp_register_start_date trsd ON trsd.patient_id  = o.patient_id #{site_manager(operator: 'AND', column: 'trsd.site_id', location: @location)}
+          WHERE o.concept_id  IN (SELECT concept_id FROM concept_set WHERE concept_set = 1085)
+          AND o.start_date < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')} AND o.start_date >= COALESCE(trsd.start_date, DATE('1901-01-01'))
+          and o.order_type_id = 1 ANd o.voided  = 0 #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+          GROUP BY o.patient_id;
+        SQL
+      end
+
+      def create_temp_register_start_date_table(end_date)
+        type_of_patient_concept = concept('Type of patient').concept_id
+        new_patient_concept = concept('New patient').concept_id
+        exe_temp_register_start_date_table(adapter: @adapter)
+        ActiveRecord::Base.connection.execute <<-SQL
+          INSERT INTO temp_register_start_date (patient_id, start_date, site_id)
+          SELECT pp.patient_id as patient_id, MIN(o.obs_datetime) AS start_date, pp.site_id as site_id
+          FROM patient_program pp
+          INNER JOIN temp_other_patient_types tmp ON tmp.patient_id = pp.patient_id #{site_manager(operator: 'AND', column: 'pp.site_id', location: @location)}
+          INNER JOIN obs o ON pp.patient_id = o.person_id AND o.concept_id = #{type_of_patient_concept} #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+          AND o.value_coded = #{new_patient_concept}
+          AND o.voided = 0 AND o.obs_datetime < DATE(#{end_date}) + INTERVAL 1 DAY
+          WHERE pp.program_id = 1 #{site_manager(operator: 'AND', column: 'pp.site_id', location: @location)}
+          GROUP BY pp.patient_id #{@adapter == 'mysql2' ? '' : ', pp.site_id'}
+        SQL
+      end
+
+      def drop_temp_register_start_date_table
+        ActiveRecord::Base.connection.execute <<~SQL
+          DROP TABLE IF EXISTS temp_register_start_date
+        SQL
+      end
+
+      def remove_drug_refills_and_external_consultation(end_date)
+        ActiveRecord::Base.connection.execute <<~SQL
+          DELETE FROM temp_cohort_members
+          WHERE #{in_manager(column: 'patient_id', values: drug_refills_and_external_consultation_list(end_date))}
+        SQL
+      end
+
+      # this just gives all clients who are truly external or drug refill
+      # rubocop:disable Metrics/MethodLength
+      # rubocop:disable Metrics/AbcSize
+      def drug_refills_and_external_consultation_list(end_date)
+        to_remove = [0]
+
+        type_of_patient_concept = concept('Type of patient').concept_id
+        new_patient_concept = concept('New patient').concept_id
+        drug_refill_concept = concept('Drug refill').concept_id
+        external_concept = concept('External consultation').concept_id
+        hiv_clinic_registration_id = ::EncounterType.find_by_name('HIV CLINIC REGISTRATION').encounter_type_id
+
+        ActiveRecord::Base.connection.select_all("SELECT e.patient_id
+        FROM temp_cohort_members e
+        LEFT JOIN encounter as hiv_registration ON hiv_registration.patient_id = e.patient_id
+          AND hiv_registration.encounter_datetime < DATE(#{end_date})
+          AND hiv_registration.encounter_type = #{hiv_clinic_registration_id}
+          AND hiv_registration.voided = 0 #{site_manager(operator: 'AND', column: 'hiv_registration.site_id',
+                                                         location: @location)}
+        LEFT JOIN (SELECT * FROM obs WHERE concept_id = #{type_of_patient_concept} AND voided = 0 AND value_coded = #{new_patient_concept} AND obs_datetime < #{interval_manager(
+          date: end_date, value: 1, interval: 'DAY', operator: '+'
+        )} #{site_manager(operator: 'AND', column: 'site_id',
+                          location: @location)}) AS new_patient ON e.patient_id = new_patient.person_id
+        LEFT JOIN (SELECT * FROM obs WHERE concept_id = #{type_of_patient_concept} AND voided = 0 AND value_coded = #{drug_refill_concept} AND obs_datetime < #{interval_manager(
+          date: end_date, value: 1, interval: 'DAY', operator: '+'
+        )} #{site_manager(operator: 'AND', column: 'site_id',
+                          location: @location)}) AS refill ON e.patient_id = refill.person_id
+        LEFT JOIN (SELECT * FROM obs WHERE concept_id = #{type_of_patient_concept} AND voided = 0 AND value_coded = #{external_concept} AND DATE(obs_datetime) < #{interval_manager(
+          date: end_date, value: 1, interval: 'DAY', operator: '+'
+        )} #{site_manager(operator: 'AND', column: 'site_id',
+                          location: @location)}) AS external ON e.patient_id = external.person_id
+        WHERE (refill.value_coded IS NOT NULL OR external.value_coded IS NOT NULL)
+        AND NOT (hiv_registration.encounter_id IS NOT NULL OR new_patient.value_coded IS NOT NULL)
+        GROUP BY e.patient_id
+        ORDER BY MAX(hiv_registration.encounter_datetime) DESC, MAX(refill.obs_datetime) DESC, MAX(external.obs_datetime) DESC;").each do |record|
+          to_remove << record['patient_id'].to_i
+        end
+        to_remove.join(',')
+      end
+      # rubocop:enable Metrics/MethodLength
+      # rubocop:enable Metrics/AbcSize
+
+      def create_tmp_patient_table
+        ActiveRecord::Base.connection.execute('DROP TABLE IF EXISTS temp_earliest_start_date')
+        exe_tmp_patient_table(adapter: @adapter)
+
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX patient_id_index ON temp_earliest_start_date (patient_id)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX site_id_tesd ON temp_earliest_start_date (site_id)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX patient_id__site_id_index ON temp_earliest_start_date (patient_id, site_id)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX date_enrolled_index ON temp_earliest_start_date (date_enrolled)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX patient_id__date_enrolled_index ON temp_earliest_start_date (patient_id, date_enrolled)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX earliest_start_date_index ON temp_earliest_start_date (earliest_start_date)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX earliest_start_date__date_enrolled_index ON temp_earliest_start_date (patient_id, earliest_start_date, date_enrolled, gender)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX idx_reason_for_art ON temp_earliest_start_date (reason_for_starting_art)'
+        )
+        ActiveRecord::Base.connection.execute(
+          'CREATE INDEX birthdate_idx ON temp_earliest_start_date (birthdate)'
+        )
+      end
+
+      def update_cum_outcome(end_date)
+        MalawiHivProgramReports::Cohort::Outcomes.new(end_date:, definition: @outcomes_definition, location: @location)
+                                                 .update_cummulative_outcomes
+      end
+
+      def update_tb_status(end_date)
+        ActiveRecord::Base.connection.execute(
+          'DROP TABLE IF EXISTS temp_patient_tb_status'
+        )
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE TABLE temp_patient_tb_status (
+            patient_id INT PRIMARY KEY,
+            site_id INT DEFAULT #{@location},
+            tb_status INT
+          )
+        SQL
+
+        ActiveRecord::Base.connection.execute('CREATE INDEX tb_status_index ON temp_patient_tb_status (tb_status)')
+        ActiveRecord::Base.connection.execute('CREATE INDEX site_id_tpts ON temp_patient_tb_status (site_id)')
+        ActiveRecord::Base.connection.execute('CREATE INDEX patient_id_site_id_index ON temp_patient_tb_status (patient_id, site_id)')
+        ActiveRecord::Base.connection.execute('CREATE INDEX patient_id_tb_status_index ON temp_patient_tb_status (patient_id, tb_status)')
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          INSERT INTO temp_patient_tb_status (patient_id, tb_status)
+            SELECT e.patient_id, obs.value_coded
+            FROM temp_earliest_start_date e
+            INNER JOIN temp_patient_outcomes o ON o.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+            RIGHT JOIN obs ON obs.person_id = o.patient_id #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+            WHERE e.date_enrolled <= '#{end_date}' AND obs.obs_datetime <= '#{end_date} 23:59:59'
+            AND LOWER(cum_outcome) = LOWER('On antiretrovirals') AND obs.voided = 0
+            AND obs.concept_id = 7459 #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+            AND obs.obs_datetime = (
+              SELECT MAX(t.obs_datetime) FROM obs t WHERE t.concept_id = 7459 AND t.voided = 0
+              AND t.person_id = e.patient_id AND t.obs_datetime <= '#{end_date} 23:59:59' #{site_manager(operator: 'AND', column: 't.site_id', location: @location)}
+            ) GROUP BY e.patient_id #{@adapter == 'mysql2' ? '' : ', obs.value_coded'}
+        SQL
+      end
+
+      def update_patient_side_effects(end_date)
+        MalawiHivProgramReports::Cohort::SideEffects.new.update_side_effects(end_date, @location)
+      end
+
+      private
+
+      def total_patients_with_screened_bp(total_alive_and_on_art, _start_date, end_date)
+        return 0 if total_alive_and_on_art.blank? || total_alive_and_on_art.empty?
+
+        bp_concepts = ::ConceptName.where(name: ['Systolic blood pressure', 'Diastolic blood pressure'])
+                                   .select(:concept_id)
+
+        results = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT o.person_id
+          FROM obs o
+          INNER JOIN (
+            SELECT person_id, MAX(obs.obs_datetime) AS obs_datetime
+            FROM obs
+            WHERE voided = 0 AND concept_id IN (#{bp_concepts.to_sql})
+              AND (value_text IS NOT NULL OR value_numeric IS NOT NULL)
+              AND obs_datetime < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')} AND obs_datetime >= #{interval_manager(date: end_date, value: 12, interval: 'MONTH', operator: '-')}
+              AND #{in_manager(column: 'person_id', values: total_alive_and_on_art)} #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+            GROUP BY person_id
+          ) AS max_obs
+            ON max_obs.person_id = o.person_id
+            AND max_obs.obs_datetime = o.obs_datetime
+          WHERE o.voided = 0 #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+            AND o.concept_id IN (#{bp_concepts.to_sql})
+            AND (o.value_text IS NOT NULL OR o.value_numeric IS NOT NULL)
+          GROUP BY o.person_id
+        SQL
+
+        ((results.count.to_f / total_alive_and_on_art.count) * 100).to_i
+      end
+
+      def total_patients_alive_and_on_art_above_30_years(total_alive_and_on_art, end_date)
+        return nil if total_alive_and_on_art.blank?
+        return nil if total_alive_and_on_art.empty?
+
+        results = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT tesd.patient_id, #{@adapter == 'mysql2' ? "TIMESTAMPDIFF(YEAR, tesd.birthdate, DATE('#{end_date}')) AS age" : "(EXTRACT(YEAR FROM AGE(DATE('#{end_date}'), tesd.birthdate))) AS age"}
+          FROM temp_earliest_start_date tesd
+          WHERE #{in_manager(column: 'tesd.patient_id', values: total_alive_and_on_art.map { |r| r['patient_id'].to_i }.join(','))}
+          GROUP BY tesd.patient_id
+          HAVING  #{@adapter == 'mysql2' ? 'age' : "(EXTRACT(YEAR FROM AGE(DATE('#{end_date}'), tesd.birthdate)))"} >= 30
+        SQL
+
+        # map the results to patient ids
+        results&.map { |r| r['patient_id'].to_i }
+      end
+
+      def total_patients_on_family_planning(patients_list, start_date, end_date)
+        patient_ids = []
+        patient_list = []
+
+        (patients_list || []).each do |row|
+          patient_ids << row['patient_id'].to_i
+        end
+
+        return [] if patient_ids.blank?
+
+        all_women = ActiveRecord::Base.connection.select_all(
+          "SELECT * FROM temp_earliest_start_date
+          WHERE gender IN ('F','Female') AND patient_id IN  (#{patient_ids.join(',')})
+          AND date_enrolled BETWEEN '#{start_date.to_date}' AND '#{end_date.to_date}' #{site_manager(operator: 'AND',
+                                                                                                     column: 'site_id', location: @location)}
+          GROUP BY patient_id"
+        )
+
+        (all_women || []).each do |patient|
+          patient_list << patient['patient_id'].to_i
+        end
+
+        return 0 if patient_list.blank?
+
+        hiv_clinic_consultation_encounter_type_id = encounter_type('HIV CLINIC CONSULTATION').encounter_type_id
+        method_of_family_planning_concept_id = concept('Method of family planning').concept_id
+        family_planning_action_to_take_concept_id = concept('Family planning, action to take').concept_id
+        none_concept_id = [concept('None').concept_id, concept('No').concept_id]
+
+        results = ActiveRecord::Base.connection.select_all(
+          "SELECT o.person_id
+          FROM obs o
+          INNER JOIN encounter e on e.encounter_id = o.encounter_id AND e.encounter_type = #{hiv_clinic_consultation_encounter_type_id} #{site_manager(
+            operator: 'AND', column: 'e.site_id', location: @location
+          )}
+          WHERE o.voided = 0 AND e.voided = 0 #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+          AND #{in_manager(column: 'o.concept_id',
+                           values: [family_planning_action_to_take_concept_id,
+                                    method_of_family_planning_concept_id])}
+          AND #{in_manager(column: 'o.value_coded', values: none_concept_id.join(','), negation: true)}
+          AND #{in_manager(column: 'o.person_id', values: patient_list.join(','))}
+          AND o.obs_datetime BETWEEN '#{start_date.to_date.strftime('%Y-%m-%d 00:00:00')}'
+          AND '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}'
+          AND DATE(o.obs_datetime) = (SELECT max(date(obs.obs_datetime)) FROM obs obs
+            WHERE obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+            AND #{in_manager(column: 'obs.concept_id',
+                             values: [family_planning_action_to_take_concept_id,
+                                      method_of_family_planning_concept_id])}
+            AND obs.obs_datetime BETWEEN '#{start_date.to_date.strftime('%Y-%m-%d 00:00:00')}' AND '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}'
+            AND obs.person_id = o.person_id) #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+          GROUP BY o.person_id"
+        )
+
+        begin
+          ((results.count.to_f / patient_list.count) * 100).to_i
+        rescue StandardError
+          0
+        end
+      end
+
+      def total_patients_on_arvs_and_ipt(patients_list, start_date, end_date)
+        isoniazid_concept_id = concept('Isoniazid').concept_id
+        pyridoxine_concept_id = concept('Pyridoxine').concept_id
+
+        patient_ids = []
+        (patients_list || []).each do |row|
+          patient_ids << row['patient_id'].to_i
+        end
+
+        return [] if patient_ids.blank?
+
+        results = ActiveRecord::Base.connection.select_all(
+          "SELECT ods.patient_id
+          FROM orders ods
+          INNER JOIN drug_order dos ON ods.order_id = dos.order_id AND ods.voided = 0 #{site_manager(operator: 'AND',
+                                                                                                     column: 'dos.site_id', location: @location)}
+          WHERE #{in_manager(column: 'ods.concept_id', values: [isoniazid_concept_id, pyridoxine_concept_id])}
+          AND dos.quantity IS NOT NULL #{site_manager(operator: 'AND', column: 'ods.site_id', location: @location)}
+          AND #{in_manager(column: 'ods.patient_id', values: patient_ids)}
+          AND ods.start_date BETWEEN '#{start_date.to_date.strftime('%Y-%m-%d 00:00:00')}'
+          AND '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}'
+          AND DATE(ods.start_date) = (SELECT MAX(DATE(o.start_date)) FROM orders o
+                                      INNER JOIN drug_order d ON o.order_id = d.order_id AND o.voided = 0 #{site_manager(
+                                        operator: 'AND', column: 'd.site_id', location: @location
+                                      )}
+                                      WHERE #{in_manager(column: 'o.concept_id',
+                                                         values: [
+                                                           isoniazid_concept_id, pyridoxine_concept_id
+                                                         ])}
+                                      AND o.patient_id = ods.patient_id #{site_manager(operator: 'AND',
+                                                                                       column: 'o.site_id', location: @location)}
+                                      AND d.quantity IS NOT NULL
+                                      AND o.start_date BETWEEN '#{start_date.to_date.strftime('%Y-%m-%d 00:00:00')}'
+                                      AND '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}')
+          GROUP BY ods.patient_id"
+        )
+
+        ((results.count.to_f / patient_ids.count) * 100).to_i
+      end
+
+      def total_patients_on_arvs_and_cpt(patients_list, start_date, end_date)
+        cpt_concept_id = concept('Cotrimoxazole').concept_id
+
+        patient_ids = []
+        (patients_list || []).each do |row|
+          patient_ids << row['patient_id'].to_i
+        end
+
+        return [] if patient_ids.blank?
+
+        results = ActiveRecord::Base.connection.select_all(
+          "SELECT ods.patient_id
+          FROM orders ods
+          INNER JOIN drug_order dos ON ods.order_id = dos.order_id AND ods.voided = 0 #{site_manager(operator: 'AND',
+                                                                                                     column: 'dos.site_id', location: @location)}
+          WHERE ods.concept_id = #{cpt_concept_id}
+          AND dos.quantity > 0 #{site_manager(operator: 'AND', column: 'ods.site_id', location: @location)}
+          AND ods.patient_id in (#{patient_ids.join(',')})
+          AND ods.start_date BETWEEN '#{start_date.to_date.strftime('%Y-%m-%d 00:00:00')}'
+          AND '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}'
+          AND DATE(ods.start_date) = (SELECT MAX(DATE(o.start_date)) FROM orders o
+                                      INNER JOIN drug_order d ON o.order_id = d.order_id AND o.voided = 0 #{site_manager(
+                                        operator: 'AND', column: 'd.site_id', location: @location
+                                      )}
+                                      WHERE o.concept_id =  #{cpt_concept_id} #{site_manager(operator: 'AND',
+                                                                                             column: 'o.site_id', location: @location)}
+                                      AND d.quantity > 0
+                                      AND o.patient_id = ods.patient_id
+                                      AND o.start_date BETWEEN '#{start_date.to_date.strftime('%Y-%m-%d 00:00:00')}'
+                                      AND '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}')
+
+          GROUP BY ods.patient_id"
+        )
+
+        ((results.count.to_f / patient_ids.count) * 100).to_i
+      end
+
+      def total_breastfeeding_women(_patients_list, total_pregnant_women, _start_date, end_date)
+        total_pregnant_women = if total_pregnant_women.empty?
+                                 [0]
+                               else
+                                 total_pregnant_women.map { |woman| woman['person_id'].to_i }
+                               end
+
+        encounter_types = ::EncounterType.where('LOWER(name) IN (?)',
+                                                ['HIV CLINIC CONSULTATION'.downcase, 'HIV STAGING'.downcase])
+                                         .select(:encounter_type_id)
+
+        breastfeeding_concepts = ::ConceptName.where('LOWER(name) IN (?)',
+                                                     ['Breast feeding?'.downcase, 'Breast feeding'.downcase,
+                                                      'Breastfeeding'.downcase])
+                                              .select(:concept_id)
+
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT obs.person_id, obs.value_coded
+          FROM obs
+          INNER JOIN encounter enc
+            ON enc.encounter_id = obs.encounter_id
+            AND enc.voided = 0 #{site_manager(operator: 'AND', column: 'enc.site_id', location: @location)}
+            AND enc.encounter_type IN (#{encounter_types.to_sql})
+          INNER JOIN temp_earliest_start_date e
+            ON e.patient_id = enc.patient_id #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+            AND LEFT(e.gender, 1) = 'F'
+          INNER JOIN temp_patient_outcomes
+            ON temp_patient_outcomes.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 'temp_patient_outcomes.site_id', location: @location)}
+            AND temp_patient_outcomes.cum_outcome = 'On antiretrovirals'
+          INNER JOIN (
+            SELECT person_id, MAX(obs_datetime) AS obs_datetime
+            FROM obs
+            INNER JOIN encounter
+              ON encounter.encounter_id = obs.encounter_id
+              AND encounter.encounter_type IN (#{encounter_types.to_sql})
+              AND encounter.voided = 0 #{site_manager(operator: 'AND', column: 'encounter.site_id', location: @location)}
+            WHERE person_id IN (SELECT patient_id FROM temp_patient_outcomes WHERE cum_outcome = 'On antiretrovirals')
+              AND concept_id IN (#{breastfeeding_concepts.to_sql})
+              AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+              AND obs_datetime < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')}
+            GROUP BY person_id
+          ) AS max_obs
+            ON max_obs.person_id = obs.person_id
+            AND max_obs.obs_datetime = obs.obs_datetime
+          WHERE obs.person_id = e.patient_id
+            AND #{in_manager(column: 'obs.person_id', values: total_pregnant_women.join(','), negation: true)}
+            AND obs.obs_datetime < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')}
+            AND obs.concept_id IN (#{breastfeeding_concepts.to_sql})
+            AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+          GROUP BY obs.person_id #{@adapter == 'mysql2' ? '' : ', obs.value_coded'}
+          HAVING value_coded = 1065
+          ORDER BY MAX(obs.obs_datetime) DESC;
+        SQL
+      end
+
+      def total_pregnant_women(_patients_list, _start_date, end_date)
+        encounter_types = ::EncounterType.where('LOWER(name) IN (?)',
+                                                ['HIV CLINIC CONSULTATION'.downcase, 'HIV STAGING'.downcase])
+                                         .select(:encounter_type_id)
+
+        pregnant_concepts = ::ConceptName.where('LOWER(name) IN (?)',
+                                                ['Is patient pregnant?'.downcase, 'patient pregnant'.downcase])
+                                         .select(:concept_id)
+
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT obs.person_id, obs.value_coded
+          FROM obs obs
+            INNER JOIN encounter enc
+              ON enc.encounter_id = obs.encounter_id
+              AND enc.voided = 0 #{site_manager(operator: 'AND', column: 'enc.site_id', location: @location)}
+              AND enc.encounter_type IN (#{encounter_types.to_sql})
+            INNER JOIN temp_earliest_start_date e
+              ON e.patient_id = enc.patient_id #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+              AND LEFT(e.gender, 1) = 'F'
+          INNER JOIN temp_patient_outcomes
+            ON temp_patient_outcomes.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 'temp_patient_outcomes.site_id', location: @location)}
+            AND temp_patient_outcomes.cum_outcome = 'On antiretrovirals'
+          INNER JOIN (
+            SELECT person_id, MAX(obs_datetime) AS obs_datetime
+            FROM obs
+            INNER JOIN encounter
+              ON encounter.encounter_id = obs.encounter_id #{site_manager(operator: 'AND', column: 'encounter.site_id', location: @location)}
+              AND encounter.encounter_type IN (#{encounter_types.to_sql})
+              AND encounter.voided = 0
+            WHERE concept_id IN (#{pregnant_concepts.to_sql})
+              AND obs_datetime < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')}
+              AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+            GROUP BY person_id
+          ) AS max_obs
+            ON max_obs.person_id = obs.person_id
+            AND max_obs.obs_datetime = obs.obs_datetime
+          WHERE obs.concept_id IN (#{pregnant_concepts.to_sql})
+            AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+          GROUP BY obs.person_id #{@adapter == 'mysql2' ? '' : ', obs.value_coded'}
+          HAVING obs.value_coded = 1065
+          ORDER BY MAX(obs.obs_datetime) DESC;
+        SQL
+      end
+
+      def total_other_patients(patient_list, all_breastfeeding_women, all_pregnant_women)
+        patient_ids = []
+        all_pregnant_women_ids = []
+        all_breastfeeding_women_ids = []
+
+        (patient_list || []).each do |row|
+          patient_ids << row['patient_id'].to_i
+        end
+
+        (all_pregnant_women || []).each do |row|
+          all_pregnant_women_ids << row['person_id'].to_i
+        end
+
+        (all_breastfeeding_women || []).each do |row|
+          all_breastfeeding_women_ids << row['person_id'].to_i
+        end
+
+        (patient_ids - (all_breastfeeding_women_ids + all_pregnant_women_ids))
+      end
+
+      MIN_ART_ADHERENCE_THRESHOLD = 95.0 # Those below are not adherent
+      MAX_ART_ADHERENCE_THRESHOLD = 105.0 # Thoseabove are not adherent
+
+      # Groups patients list into three groups based on the adherence rates
+      #
+      # Returns: A list of 3 lists as follows:
+      #    [
+      #       [adherent patients],
+      #       [inadherent patients],
+      #       [patients whose adherence rate is unknown]
+      #    ]
+      def latest_art_adherence(patients_alive_and_on_art, _start_date, end_date)
+        patients_alive_and_on_art = Set.new(patients_alive_and_on_art.map { |patient| patient['patient_id'] })
+        end_date = ActiveRecord::Base.connection.quote(end_date)
+
+        not_adherent = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT adherence.person_id
+          FROM obs AS adherence
+          INNER JOIN (
+            SELECT obs.person_id, DATE(MAX(obs.obs_datetime)) AS visit_date
+            FROM obs
+            INNER JOIN orders
+              ON orders.order_id = obs.order_id #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)}
+              AND orders.concept_id IN (#{arv_drug_concepts.to_sql})
+              AND orders.order_type_id = #{drug_order_type.order_type_id}
+              AND orders.voided = 0
+            INNER JOIN temp_patient_outcomes
+              ON temp_patient_outcomes.patient_id = obs.person_id #{site_manager(operator: 'AND', column: 'temp_patient_outcomes.site_id', location: @location)}
+              AND LOWER(temp_patient_outcomes.cum_outcome) = LOWER('On antiretrovirals')
+            WHERE obs.concept_id = #{drug_order_adherence_concept.concept_id}
+              AND obs.obs_datetime < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')}
+              AND (obs.value_numeric IS NOT NULL OR obs.value_text IS NOT NULL)
+              AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+            GROUP BY obs.person_id
+          ) AS max_adherence
+            ON max_adherence.person_id = adherence.person_id
+            AND adherence.obs_datetime >= max_adherence.visit_date #{site_manager(operator: 'AND', column: 'adherence.site_id', location: @location)}
+            AND adherence.obs_datetime < #{interval_manager(date: 'max_adherence.visit_date', value: 1, interval: 'DAY', operator: '+')}
+          INNER JOIN orders
+            ON orders.order_id = adherence.order_id
+            AND orders.order_type_id = #{drug_order_type.order_type_id}
+            AND orders.concept_id IN (#{arv_drug_concepts.to_sql})
+            AND orders.voided = 0 #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)}
+          WHERE adherence.concept_id = #{drug_order_adherence_concept.concept_id}
+            AND (
+                  (adherence.value_numeric < #{MIN_ART_ADHERENCE_THRESHOLD} OR adherence.value_numeric > #{MAX_ART_ADHERENCE_THRESHOLD})
+                  OR
+                  (#{@adapter == 'mysql2' ? 'CAST(adherence.value_text AS SIGNED INTEGER)' : 'CAST(adherence.value_text AS INTEGER)'} < #{MIN_ART_ADHERENCE_THRESHOLD}
+                    OR #{@adapter == 'mysql2' ? 'CAST(adherence.value_text AS SIGNED INTEGER)' : 'CAST(adherence.value_text AS INTEGER)'} > #{MAX_ART_ADHERENCE_THRESHOLD})
+                )
+            AND adherence.voided = 0 #{site_manager(operator: 'AND', column: 'adherence.site_id', location: @location)}
+          GROUP BY adherence.person_id
+        SQL
+
+        not_adherent = not_adherent.empty? ? [] : not_adherent.map { |row| row['person_id'] }
+
+        adherent = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT adherence.person_id
+          FROM obs AS adherence
+          INNER JOIN (
+            SELECT obs.person_id, DATE(MAX(obs.obs_datetime)) AS visit_date
+            FROM obs
+            INNER JOIN orders
+              ON orders.order_id = obs.order_id
+              AND orders.concept_id IN (#{arv_drug_concepts.to_sql})
+              AND orders.order_type_id = #{drug_order_type.order_type_id}
+              AND orders.voided = 0 #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)}
+            INNER JOIN temp_patient_outcomes
+              ON temp_patient_outcomes.patient_id = obs.person_id #{site_manager(operator: 'AND', column: 'temp_patient_outcomes.site_id', location: @location)}
+              AND #{in_manager(column: 'temp_patient_outcomes.patient_id', values: not_adherent.blank? ? [0] : not_adherent.join(','), negation: true)}
+              AND LOWER(temp_patient_outcomes.cum_outcome) = LOWER('On antiretrovirals')
+            WHERE obs.concept_id = #{drug_order_adherence_concept.concept_id}
+              AND obs.obs_datetime < #{interval_manager(date: end_date, value: 1, interval: 'DAY', operator: '+')}
+              AND (obs.value_numeric IS NOT NULL OR obs.value_text IS NOT NULL)
+              AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+            GROUP BY obs.person_id
+          ) AS max_adherence
+            ON max_adherence.person_id = adherence.person_id
+            AND adherence.obs_datetime >= max_adherence.visit_date #{site_manager(operator: 'AND', column: 'adherence.site_id', location: @location)}
+            AND adherence.obs_datetime < #{interval_manager(date: 'max_adherence.visit_date', value: 1, interval: 'DAY', operator: '+')}
+          INNER JOIN orders
+            ON orders.order_id = adherence.order_id
+            AND orders.order_type_id = #{drug_order_type.order_type_id}
+            AND orders.concept_id IN (#{arv_drug_concepts.to_sql})
+            AND orders.voided = 0 #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)}
+          WHERE adherence.concept_id = #{drug_order_adherence_concept.concept_id}
+            AND ((adherence.value_numeric >= #{MIN_ART_ADHERENCE_THRESHOLD}
+                  OR adherence.value_numeric <= #{MAX_ART_ADHERENCE_THRESHOLD})
+                 OR (#{@adapter == 'mysql2' ? 'CAST(adherence.value_text AS SIGNED INTEGER)' : 'CAST(adherence.value_text AS INTEGER)'} >= #{MIN_ART_ADHERENCE_THRESHOLD}
+                     OR #{@adapter == 'mysql2' ? 'CAST(adherence.value_text AS SIGNED INTEGER)' : 'CAST(adherence.value_text AS INTEGER)'} <= #{MAX_ART_ADHERENCE_THRESHOLD}))
+            AND adherence.voided = 0 #{site_manager(operator: 'AND', column: 'adherence.site_id', location: @location)}
+          GROUP BY adherence.person_id
+        SQL
+
+        adherent = adherent.map { |row| row['person_id'] }
+        unknown_adherence = patients_alive_and_on_art.to_a - adherent - not_adherent
+        Rails.logger.info "Adherent: #{adherent.uniq.count}, Not Adherent: #{not_adherent.uniq.count}, Unknown: #{unknown_adherence.uniq.count}"
+        [adherent.uniq, not_adherent.uniq, unknown_adherence]
+      end
+
+      def adherence_encounter
+        @adherence_encounter ||= encounter_type('ART ADHERENCE')
+      end
+
+      def hiv_program
+        @hiv_program ||= program('HIV PROGRAM')
+      end
+
+      def drug_order_adherence_concept
+        @drug_order_adherence_concept ||= concept('Drug order adherence')
+      end
+
+      def drug_order_type
+        @drug_order_type ||= order_type('Drug order')
+      end
+
+      def arv_drug_concepts
+        @arv_drug_concepts ||= ::ConceptSet.where(set: concept('Antiretroviral drugs'))
+                                           .select(:concept_id)
+      end
+
+      def write_tb_status_indicators(cohort_struct, _patients_alive_and_on_art, _start_date, end_date)
+        cohort_struct.tb_suspected = []
+        cohort_struct.tb_not_suspected = []
+        cohort_struct.tb_confirmed_on_tb_treatment = []
+        cohort_struct.tb_confirmed_currently_not_yet_on_tb_treatment = []
+        cohort_struct.unknown_tb_status = []
+
+        tb_suspected_concept = concept('TB Suspected')
+        tb_not_suspected_concept = concept('TB Not Suspected')
+        tb_confirmed_but_not_on_treatment = concept('Confirmed TB NOT on Treatment')
+        tb_confirmed_and_on_treatment = concept('Confirmed TB on Treatment')
+
+        # patients_alive_and_on_art
+        (all_tb_statuses(end_date) || []).each do |data|
+          tb_status_value = begin
+            data['tb_status'].to_i
+          rescue StandardError
+            nil
+          end
+
+          case tb_status_value
+          when tb_suspected_concept.concept_id
+            cohort_struct.tb_suspected << data['patient_id']
+          when tb_not_suspected_concept.concept_id
+            cohort_struct.tb_not_suspected << data['patient_id']
+          when tb_confirmed_and_on_treatment.concept_id
+            cohort_struct.tb_confirmed_on_tb_treatment << data['patient_id']
+          when tb_confirmed_but_not_on_treatment.concept_id
+            cohort_struct.tb_confirmed_currently_not_yet_on_tb_treatment << data['patient_id']
+          else
+            cohort_struct.unknown_tb_status << data['patient_id']
+          end
+        end
+      end
+
+      def all_tb_statuses(end_date)
+        ActiveRecord::Base.connection.select_all("
+          SELECT e.*, tb_status
+          FROM temp_earliest_start_date e
+          LEFT JOIN temp_patient_tb_status s ON s.patient_id = e.patient_id #{site_manager(operator: 'AND',
+                                                                                           column: 's.site_id', location: @location)}
+          INNER JOIN temp_patient_outcomes o ON o.patient_id = e.patient_id #{site_manager(operator: 'AND',
+                                                                                           column: 'o.site_id', location: @location)}
+          WHERE LOWER(o.cum_outcome) = LOWER('On antiretrovirals') #{site_manager(operator: 'AND', column: 'e.site_id',
+                                                                                  location: @location)}
+          AND DATE(e.date_enrolled) <= '#{end_date.to_date}';
+        ")
+      end
+
+      def get_tb_status(tb_status)
+        registered = []
+        (@tb_status || []).each do |status|
+          if tb_status == status[:tb_status]
+            registered << { patient_id: status[:patient_id], tb_status: status[:tb_status] }
+          end
+        end
+
+        registered
+      end
+
+      def patients_side_effects_status(_patients_alive_and_on_art, end_date)
+        with_side_effects = []
+        without_side_effects = []
+        unknowns = []
+
+        records = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT e.*, s.has_se
+          FROM temp_earliest_start_date e
+          INNER JOIN temp_patient_side_effects s ON s.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 's.site_id', location: @location)}
+          INNER JOIN temp_patient_outcomes o ON o.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+          WHERE LOWER(o.cum_outcome) = LOWER('On antiretrovirals') #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+          AND DATE(e.date_enrolled) <= '#{end_date.to_date}';
+        SQL
+
+        (records || []).each do |data|
+          if data['has_se'] == 'Yes'
+            with_side_effects << data['patient_id']
+          elsif data['has_se'] == 'No'
+            without_side_effects << data['patient_id']
+          else
+            unknowns << data['patient_id']
+          end
+        end
+
+        [with_side_effects, without_side_effects, unknowns]
+      end
+
+      COHORT_REGIMENS = %w[
+        0P 2P 4PP 4PA 9PP 9PA 11PP 11PA 12PP 12PA 14PP 14PA 15PP 15PA 16P 17PP 17PA
+        4A 5A 6A 7A 8A 9A 10A 11A 12A 13A 14A 15A 16A 17A
+      ].freeze
+
+      def cal_regimem_category(_patient_list, end_date)
+        MalawiHivProgramReports::Cohort::Regimens.new.patient_regimens(end_date, @location).map do |prescription|
+          regimen = prescription['regimen_category']&.upcase
+
+          regimen = 'unknown_regimen' if regimen == 'Unknown'.upcase || !COHORT_REGIMENS.include?(regimen)
+
+          {
+            patient_id: prescription['patient_id'],
+            regimen_category: regimen,
+            drugs: prescription['drugs'].split(',').collect(&:to_i),
+            prescription_date: prescription['prescription_date']
+          }
+        end
+      end
+
+      def filter_prescriptions_by_regimen(prescriptions, regimen)
+        prescriptions.select do |prescription|
+          prescription[:regimen_category].casecmp?(regimen)
+        end
+      end
+
+      def filter_prescriptions_by_drugs(prescriptions, drug_ids)
+        prescriptions.select do |prescription|
+          prescription[:drugs].find { |drug_id| drug_ids.include?(drug_id) }
+        end
+      end
+
+      def died_in(month_str)
+        registered = []
+        if month_str == '4+ months'
+          data = ActiveRecord::Base.connection.select_all(
+            "SELECT t.patient_id, #{function_manager(function: 'died_in', location: @location,
+                                                     args: "t.patient_id, cum_outcome, earliest_start_date, #{@location}")} died_in
+            FROM temp_patient_outcomes o
+            INNER JOIN temp_earliest_start_date t ON t.patient_id = o.patient_id #{site_manager(operator: 'AND',
+                                                                                                column: 't.site_id', location: @location)}
+            WHERE cum_outcome = 'Patient died' #{site_manager(operator: 'AND', column: 'o.site_id',
+                                                              location: @location)}
+            GROUP BY t.patient_id #{@adapter == 'mysql2' ? '' : ', cum_outcome, earliest_start_date'}
+            HAVING LOWER(#{if @adapter == 'mysql2'
+                             'died_in'
+                           else
+                             function_manager(function: 'died_in', location: @location,
+                                              args: "t.patient_id, cum_outcome, earliest_start_date, #{@location}")
+                           end}) IN (LOWER('4+ months'), LOWER('Unknown'))"
+          )
+        else
+          data = ActiveRecord::Base.connection.select_all(
+            "SELECT t.patient_id, #{function_manager(function: 'died_in', location: @location,
+                                                     args: "t.patient_id, cum_outcome, earliest_start_date, #{@location}")} died_in
+            FROM temp_patient_outcomes o
+            INNER JOIN temp_earliest_start_date t ON t.patient_id = o.patient_id #{site_manager(operator: 'AND',
+                                                                                                column: 't.site_id', location: @location)}
+            WHERE cum_outcome = 'Patient died' #{site_manager(operator: 'AND', column: 'o.site_id',
+                                                              location: @location)}
+            GROUP BY t.patient_id #{@adapter == 'mysql2' ? '' : ', cum_outcome, earliest_start_date'}
+            HAVING LOWER(#{if @adapter == 'mysql2'
+                             'died_in'
+                           else
+                             function_manager(function: 'died_in', location: @location,
+                                              args: "t.patient_id, cum_outcome, earliest_start_date, #{@location}")
+                           end}) = '#{month_str.downcase}'"
+          )
+        end
+
+        (data || []).each do |patient|
+          registered << patient['patient_id']
+        end
+
+        registered
+      end
+
+      def get_outcome(outcome)
+        sql_patch = if outcome.casecmp('Pre-ART (Continue)').zero?
+                      "LOWER(cum_outcome) = '#{outcome.downcase}' OR LOWER(cum_outcome) = LOWER('Unknown')"
+                    else
+                      "LOWER(cum_outcome) = '#{outcome.downcase}'"
+                    end
+
+        ActiveRecord::Base.connection.select_all(
+          "SELECT * FROM temp_patient_outcomes WHERE #{sql_patch} #{site_manager(operator: 'AND', column: 'site_id',
+                                                                                 location: @location)} GROUP BY patient_id"
+        )
+      end
+
+      def kaposis_sarcoma(start_date, end_date)
+        # KAPOSIS SARCOMA
+        concept_id = concept_name('KAPOSIS SARCOMA').concept_id
+        yes_concept_id = concept_name('Yes').concept_id
+        who_stages_criteria = concept_name('Who stages criteria present').concept_id
+
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT t.patient_id
+          FROM temp_earliest_start_date t
+          INNER JOIN obs ON t.patient_id = obs.person_id #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)} AND obs.voided = 0
+          WHERE t.date_enrolled BETWEEN '#{start_date}' AND '#{end_date}'
+            AND ((obs.value_coded = #{concept_id} AND obs.concept_id = #{who_stages_criteria}) OR (obs.concept_id = #{concept_id} AND obs.value_coded = #{yes_concept_id}))
+            AND DATE(obs_datetime) <= DATE(date_enrolled) #{site_manager(operator: 'AND', column: 't.site_id', location: @location)}
+          GROUP BY patient_id
+        SQL
+      end
+
+      def current_episode_of_tb(start_date, end_date)
+        # CURRENT EPISODE OF TB
+        eptb_concept_id = concept('EXTRAPULMONARY TUBERCULOSIS (EPTB)').concept_id
+        yes_concept_id = concept('Yes').concept_id
+        pulmonary_tb_concept_id = concept('PULMONARY TUBERCULOSIS').concept_id
+        current_ptb_concept_id = concept('PULMONARY TUBERCULOSIS (CURRENT)').concept_id
+        who_stages_criteria = concept('Who stages criteria present').concept_id
+
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT t.patient_id
+          FROM temp_earliest_start_date t
+          INNER JOIN obs ON t.patient_id = obs.person_id #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}'
+          AND ( (#{in_manager(column: 'value_coded', values: [eptb_concept_id, pulmonary_tb_concept_id, current_ptb_concept_id])} AND concept_id = #{who_stages_criteria} )
+            OR#{' '}
+              (#{in_manager(column: 'concept_id', values: [eptb_concept_id, pulmonary_tb_concept_id, current_ptb_concept_id])} AND value_coded = #{yes_concept_id}))
+          AND voided = 0 AND DATE(obs_datetime) <= DATE(date_enrolled) #{site_manager(operator: 'AND', column: 't.site_id', location: @location)}
+          GROUP BY patient_id
+        SQL
+      end
+
+      def tb_within_the_last_two_years(patients_with_current_tb, start_date, end_date)
+        # patients with current episode of tb
+        patients_with_current_tb_episode = []
+        (patients_with_current_tb || []).each do |patient|
+          patients_with_current_tb_episode << patient['patient_id'].to_i
+        end
+
+        patients_with_current_tb_episode = [0] if patients_with_current_tb_episode.blank?
+
+        # Pulmonary tuberculosis within the last 2 years
+        pulmonary_tb_within_last_2yrs_concept_id = concept('Pulmonary tuberculosis within the last 2 years').concept_id
+        ptb_within_the_past_two_yrs_concept_id = concept('Ptb within the past two years').concept_id
+        who_stages_criteria = concept('Who stages criteria present').concept_id
+        yes_concept_id = concept('Yes').concept_id
+
+        ActiveRecord::Base.connection.select_all(
+          "SELECT t.patient_id
+          FROM temp_earliest_start_date t
+          INNER JOIN obs ON t.patient_id = obs.person_id #{site_manager(operator: 'AND', column: 'obs.site_id',
+                                                                        location: @location)}
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}'
+            AND ((#{in_manager(column: 'value_coded',
+                               values: [pulmonary_tb_within_last_2yrs_concept_id,
+                                        ptb_within_the_past_two_yrs_concept_id])}
+            AND concept_id = #{who_stages_criteria})
+            OR ( #{in_manager(column: 'concept_id',
+                              values: [pulmonary_tb_within_last_2yrs_concept_id,
+                                       ptb_within_the_past_two_yrs_concept_id])} AND value_coded = #{yes_concept_id}))
+            AND #{in_manager(column: 'patient_id', values: patients_with_current_tb_episode.join(','),
+                             negation: true)}
+            AND voided = 0 AND DATE(obs_datetime) <= DATE(date_enrolled) #{site_manager(operator: 'AND',
+                                                                                        column: 't.site_id', location: @location)}
+          GROUP BY patient_id"
+        )
+      end
+
+      def no_tb(total_registered, tb_within_the_last_two_years, current_episode_of_tb)
+        total_registered_patients = []
+        tb_within_2yrs_patients = []
+        current_tb_episode_patients = []
+
+        (total_registered || []).each do |patient|
+          total_registered_patients << patient['patient_id'].to_i
+        end
+
+        (tb_within_the_last_two_years || []).each do |patient|
+          tb_within_2yrs_patients << patient['patient_id'].to_i
+        end
+
+        (current_episode_of_tb || []).each do |patient|
+          current_tb_episode_patients << patient['patient_id'].to_i
+        end
+
+        total_registered_patients - (tb_within_2yrs_patients + current_tb_episode_patients)
+      end
+
+      def cum_no_tb(cum_total_registered, cum_tb_within_the_last_two_years, cum_current_episode_of_tb)
+        total_registered_patients = []
+        tb_within_2yrs_patients = []
+        current_tb_episode_patients = []
+
+        (cum_total_registered || []).each do |patient|
+          total_registered_patients << patient['patient_id'].to_i
+        end
+
+        (cum_tb_within_the_last_two_years || []).each do |patient|
+          tb_within_2yrs_patients << patient['patient_id'].to_i
+        end
+
+        (cum_current_episode_of_tb || []).each do |patient|
+          current_tb_episode_patients << patient['patient_id'].to_i
+        end
+
+        total_registered_patients - (tb_within_2yrs_patients + current_tb_episode_patients)
+      end
+
+      def children_12_59_months(start_date, end_date)
+        concept = ::ConceptName.where('LOWER(name) IN (?)', 'HIV Infected'.downcase).select(:concept_id)
+
+        find_patients_by_reason_for_starting(start_date, end_date, concept)
+      end
+
+      def unknown_other_reason_outside_guidelines(start_date, end_date)
+        # All WHO stage 1 and 2 patients that were enrolled before '2016-04-01'
+        # should be included in this group.
+        unknown_concepts = ::ConceptName.where('LOWER(name) IN (?)', ['Unknown'.downcase, 'None'.downcase])
+                                        .select(:concept_id)
+                                        .to_sql
+
+        if start_date.to_date > '2016-04-01'.to_date
+          return ActiveRecord::Base.connection.select_all <<~SQL
+            SELECT patient_id
+            FROM temp_earliest_start_date
+            WHERE reason_for_starting_art IN (#{unknown_concepts})
+              AND date_enrolled >= '#{start_date}'
+              AND date_enrolled <= '#{end_date}' #{site_manager(operator: 'AND', column: 'site_id', location: @location)}
+          SQL
+        end
+
+        stage_1_and_2_concept_names = ['LYMPHOCYTE COUNT BELOW THRESHOLD WITH WHO STAGE 1'.downcase,
+                                       'LYMPHOCYTES'.downcase,
+                                       'LYMPHOCYTE COUNT BELOW THRESHOLD WITH WHO STAGE 2'.downcase,
+                                       'WHO stage I adult'.downcase,
+                                       'WHO stage I peds'.downcase,
+                                       'WHO STAGE 1'.downcase,
+                                       'WHO stage II adult'.downcase,
+                                       'WHO stage II peds'.downcase,
+                                       'WHO STAGE 2'.downcase]
+
+        stage_1_and_2_concepts = ::ConceptName.where('LOWER(name) IN (?)', stage_1_and_2_concept_names)
+                                              .select('DISTINCT concept_id')
+                                              .to_sql
+
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT patient_id
+          FROM temp_earliest_start_date
+          WHERE
+            (
+              reason_for_starting_art IN (#{unknown_concepts})
+              AND date_enrolled >= '#{start_date}'
+              AND date_enrolled <= '#{end_date}'
+            )
+            OR (
+              reason_for_starting_art IN (#{stage_1_and_2_concepts})
+              AND date_enrolled <= DATE('2016-04-01')
+            ) #{site_manager(operator: 'AND', column: 'site_id', location: @location)}
+        SQL
+      end
+
+      def who_stage_four(start_date, end_date)
+        concepts = ::ConceptName.where('LOWER(name) IN (?)',
+                                       ['WHO stage IV adult'.downcase, 'WHO stage IV peds'.downcase,
+                                        'WHO STAGE 4'.downcase])
+                                .select(:concept_id)
+        find_patients_by_reason_for_starting(start_date, end_date, concepts)
+      end
+
+      def who_stage_three(start_date, end_date)
+        concepts = ::ConceptName.where('LOWER(name) IN (?)',
+                                       ['WHO stage III adult'.downcase, 'WHO stage III peds'.downcase,
+                                        'WHO STAGE 3'.downcase])
+                                .select(:concept_id)
+        find_patients_by_reason_for_starting(start_date, end_date, concepts)
+      end
+
+      def pregnant_women(start_date, end_date)
+        concepts = ::ConceptName.where('LOWER(name) IN (?)', ['PATIENT PREGNANT'.downcase, 'Is patient pregnant at initiation?'.downcase,
+                                                              'Patient pregnant state'.downcase, 'Is patient pregnant?'.downcase])
+                                .select(:concept_id)
+        find_patients_by_reason_for_starting(start_date, end_date, concepts)
+      end
+
+      def breastfeeding_mothers(start_date, end_date)
+        concept = ::ConceptName.where('LOWER(name) IN (?)', 'Breastfeeding'.downcase).select(:concept_id)
+        find_patients_by_reason_for_starting(start_date, end_date, concept)
+      end
+
+      def asymptomatic(start_date, end_date)
+        # for WHO stage 1 and 2 to be included in asymptomatic, the patients are supposed to
+        # be enrolled on HIV PROGRAM after 2016-04-01
+        patients = []
+
+        asymptomatic_concepts = ::ConceptName.where('LOWER(name) IN (?)',
+                                                    ['ASYMPTOMATIC'.downcase, 'Asymptomatic HIV infection'.downcase])
+                                             .select(:concept_id)
+        find_patients_by_reason_for_starting(start_date, end_date, asymptomatic_concepts)
+          .each { |patient| patients << patient['patient_id'] }
+
+        reason_concepts = ::ConceptName.where(name: ['WHO stage I adult'.downcase,
+                                                     'WHO stage I peds'.downcase,
+                                                     'WHO stage 1'.downcase,
+                                                     'WHO stage II adult'.downcase,
+                                                     'WHO stage II peds'.downcase,
+                                                     'LYMPHOCYTE COUNT BELOW THRESHOLD WITH WHO STAGE 1'.downcase,
+                                                     'LYMPHOCYTES'.downcase,
+                                                     'LYMPHOCYTE COUNT BELOW THRESHOLD WITH WHO STAGE 2'.downcase])
+                                       .select(:concept_id)
+
+        revised_art_guidelines_date = '2016-04-01'.to_date
+        start_date = revised_art_guidelines_date if start_date.to_date < revised_art_guidelines_date
+
+        find_patients_by_reason_for_starting(start_date, end_date, reason_concepts)
+          .each { |patient| patients << patient['patient_id'] }
+
+        patients
+      end
+
+      def who_stage_two(start_date, end_date)
+        concepts = ::ConceptName.where('LOWER(name) IN (?)', ['CD4 COUNT LESS THAN OR EQUAL TO 750'.downcase,
+                                                              'CD4 count less than or equal to 500'.downcase,
+                                                              'CD4 COUNT LESS THAN OR EQUAL TO 350'.downcase,
+                                                              'CD4 count less than 350'.downcase,
+                                                              'CD4 count less than 250'.downcase,
+                                                              'CD4 COUNT LESS THAN OR EQUAL TO 250'.downcase])
+                                .select(:concept_id)
+        find_patients_by_reason_for_starting(start_date, end_date, concepts)
+      end
+
+      def confirmed_hiv_infection_in_infants_pcr(start_date, end_date)
+        concept = ::ConceptName.where('LOWER(name) IN (?)', 'HIV PCR'.downcase).select(:concept_id)
+        find_patients_by_reason_for_starting(start_date, end_date, concept)
+      end
+
+      def presumed_severe_hiv_disease_in_infants(start_date, end_date)
+        concepts = ::ConceptName.where('LOWER(name) IN (?)', ['PRESUMED SEVERE HIV'.downcase,
+                                                              'PRESUMED SEVERE HIV CRITERIA IN INFANTS'.downcase])
+                                .select(:concept_id)
+        find_patients_by_reason_for_starting(start_date, end_date, concepts)
+      end
+
+      def find_patients_by_reason_for_starting(start_date, end_date, reason_concept_ids)
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT patient_id
+          FROM temp_earliest_start_date
+          WHERE date_enrolled >= '#{start_date}'
+            AND date_enrolled <= '#{end_date}'
+            AND reason_for_starting_art IN (#{reason_concept_ids.to_sql}) #{site_manager(operator: 'AND', column: 'site_id', location: @location)}
+        SQL
+      end
+
+      def unknown_age(start_date, end_date)
+        ActiveRecord::Base.connection.select_all(
+          "SELECT patient_id
+          FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND',
+                                                                                       column: 'site_id', location: @location)}
+            AND (age_at_initiation IS NULL OR age_at_initiation < 0 OR birthdate IS NULL)
+          GROUP BY patient_id"
+        )
+      end
+
+      def unknown_gender(start_date, end_date)
+        ActiveRecord::Base.connection.select_all(
+          "SELECT patient_id
+          FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND',
+                                                                                       column: 'site_id', location: @location)}
+          AND gender IS NULL OR LENGTH(gender) < 1  GROUP BY patient_id;"
+        )
+      end
+
+      def adults_at_art_initiation(start_date, end_date)
+        ActiveRecord::Base.connection.select_all(
+          "SELECT patient_id FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND',
+                                                                                       column: 'site_id', location: @location)}
+          AND age_at_initiation > 14 GROUP BY patient_id"
+        )
+      end
+
+      def children_24_months_14_years_at_art_initiation(start_date, end_date)
+        ActiveRecord::Base.connection.select_all(
+          "SELECT patient_id FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND',
+                                                                                       column: 'site_id', location: @location)}
+          AND age_at_initiation BETWEEN  2 AND 14 GROUP BY patient_id"
+        )
+      end
+
+      def children_below_24_months_at_art_initiation(start_date, end_date)
+        ActiveRecord::Base.connection.select_all(
+          "SELECT patient_id FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND',
+                                                                                       column: 'site_id', location: @location)}
+          AND (age_at_initiation >= 0 AND age_at_initiation < 2) GROUP BY patient_id"
+        )
+      end
+
+      def non_pregnant_females(start_date, end_date, pregnant_women = [])
+        pregnant_women_ids = []
+        (pregnant_women || []).each do |patient|
+          pregnant_women_ids << patient
+        end
+        pregnant_women_ids = [0] if pregnant_women_ids.blank?
+
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT t.patient_id
+          FROM temp_earliest_start_date t
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND', column: 't.site_id', location: @location)}
+          AND (t.gender = 'F' OR t.gender = 'Female')
+          AND t.patient_id NOT IN(#{pregnant_women_ids.join(',')})
+          GROUP BY t.patient_id
+        SQL
+      end
+
+      def pregnant_females_all_ages(start_date, end_date)
+        yes_concept_id = concept('Yes').concept_id
+        preg_concept_id = concept('IS PATIENT PREGNANT?').concept_id
+        patient_preg_concept_id = concept('PATIENT PREGNANT').concept_id
+        preg_at_initiation_concept_id = concept('PREGNANT AT INITIATION?').concept_id
+        reason_for_starting_concept_id = concept('Reason for ART eligibility').concept_id
+
+        # (patient_id_plus_date_enrolled || []).each do |patient_id, date_enrolled|
+        registered = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT patients.*, obs.value_coded
+          FROM temp_earliest_start_date AS patients
+          INNER JOIN obs
+            ON obs.person_id = patients.patient_id
+            AND #{in_manager(column: 'obs.concept_id', values: [preg_concept_id, patient_preg_concept_id, preg_at_initiation_concept_id, reason_for_starting_concept_id])}
+            AND obs.obs_datetime >= patients.earliest_start_date
+            AND obs.obs_datetime < #{interval_manager(date: 'patients.earliest_start_date', value: 1, interval: 'DAY', operator: '+')}
+            AND #{in_manager(column: 'obs.value_coded', values: [yes_concept_id, patient_preg_concept_id])}
+            AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+          WHERE patients.gender IN ('F','Female')
+            AND patients.date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND', column: 'patients.site_id', location: @location)}
+          GROUP BY patient_id #{@adapter == 'mysql2' ? '' : ',obs.value_coded'}
+        SQL
+
+        pregnant_at_initiation = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT patient_id, #{function_manager(function: 'patient_reason_for_starting_art', location: @location,
+                                                args: "patient_id, #{@location}")}  reason_concept_id
+          FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}'
+            AND gender IN ('F','Female') #{site_manager(operator: 'AND', column: 'site_id', location: @location)}
+          GROUP BY patient_id
+          HAVING #{if @adapter == 'mysql2'
+                     'reason_concept_id IN (1755, 7972, 6131)'
+                   else
+                     in_manager(column: function_manager(function: 'patient_reason_for_starting_art', location: @location, args: "patient_id, #{@location}").to_s,
+                                values: [
+                                  1755, 7972, 6131
+                                ])
+                   end};
+        SQL
+        pregnant_at_initiation_ids = []
+        (pregnant_at_initiation || []).each do |patient|
+          pregnant_at_initiation_ids << patient['patient_id'].to_i
+        end
+
+        pregnant_at_initiation_ids = [0] if pregnant_at_initiation_ids.blank?
+
+        transfer_ins_women = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT patient_id, #{function_manager(function: 're_initiated_check', location: @location,
+                                                args: "patient_id, date_enrolled, #{@location}")} re_initiated
+          FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}'
+            AND DATE(date_enrolled) != DATE(earliest_start_date)
+            AND gender IN ('F','Female') #{site_manager(operator: 'AND', column: 'site_id', location: @location)}
+            AND #{in_manager(column: 'patient_id', values: pregnant_at_initiation_ids)}
+          GROUP BY patient_id
+          HAVING #{ if @adapter == 'mysql2'
+                      're_initiated'
+                    else
+                      function_manager(function: 're_initiated_check', location: @location,
+                                       args: "patient_id, date_enrolled, #{@location}")
+                    end} != 'Re-initiated'
+        SQL
+
+        transfer_ins_preg_women = []
+        all_pregnant_females = []
+        (transfer_ins_women || []).each do |patient|
+          transfer_ins_preg_women << patient['patient_id'].to_i if patient['patient_id'].to_i != 0
+        end
+
+        (registered || []).each do |patient|
+          all_pregnant_females << patient['patient_id'].to_i if patient['patient_id'].to_i != 0
+        end
+
+        (all_pregnant_females + transfer_ins_preg_women).uniq
+      end
+
+      def initial_females_all_ages(start_date, end_date, data)
+        clients = []
+        women = ActiveRecord::Base.connection.select_all("
+        SELECT * FROM temp_earliest_start_date e
+        WHERE patient_id IN(#{data.length.positive? ? data.join(',') : 0}) #{site_manager(operator: 'AND',
+                                                                                          column: 'e.site_id', location: @location)}
+        AND date_enrolled BETWEEN '#{start_date.to_date}' AND '#{end_date.to_date}'
+        AND DATE(date_enrolled) = DATE(earliest_start_date);")
+
+        (women || []).each do |w|
+          clients << w
+        end
+
+        clients
+      end
+
+      def males(start_date, end_date)
+        ActiveRecord::Base.connection.select_all(
+          "SELECT * FROM temp_earliest_start_date t
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND',
+                                                                                       column: 'site_id', location: @location)}
+          AND (gender = 'Male' OR gender = 'M') GROUP BY patient_id"
+        )
+      end
+
+      def transfer_in(start_date, end_date, re_initiated_on_art)
+        start_date = ActiveRecord::Base.connection.quote(start_date)
+        end_date = ActiveRecord::Base.connection.quote(end_date)
+
+        re_initiated_on_art = re_initiated_on_art.empty? ? [0] : re_initiated_on_art.rows.collect(&:first)
+
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT temp_earliest_start_date.patient_id
+          FROM temp_earliest_start_date
+          INNER JOIN clinic_registration_encounter
+            ON clinic_registration_encounter.patient_id = temp_earliest_start_date.patient_id #{site_manager(operator: 'AND', column: 'clinic_registration_encounter.site_id', location: @location)}
+          LEFT JOIN ever_registered_obs
+            ON ever_registered_obs.person_id = temp_earliest_start_date.patient_id #{site_manager(operator: 'AND', column: 'ever_registered_obs.site_id', location: @location)}
+            AND ever_registered_obs.value_coded = (
+              SELECT concept_id FROM concept_name WHERE LOWER(name) = LOWER('Yes') AND voided = 0 LIMIT 1
+            )
+          LEFT JOIN (
+              SELECT person_id, MIN(obs_datetime) AS obs_datetime
+              FROM ever_registered_obs #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)}
+              GROUP BY person_id
+            ) AS max_ever_registered_obs
+              ON max_ever_registered_obs.person_id = ever_registered_obs.person_id
+              AND max_ever_registered_obs.obs_datetime = ever_registered_obs.obs_datetime
+          LEFT JOIN obs AS last_taken_art_obs
+            ON last_taken_art_obs.encounter_id = ever_registered_obs.encounter_id
+            AND last_taken_art_obs.voided = 0 #{site_manager(operator: 'AND', column: 'last_taken_art_obs.site_id', location: @location)}
+            AND last_taken_art_obs.concept_id = (
+              SELECT concept_id FROM concept_name WHERE LOWER(name) = LOWER('DATE ART LAST TAKEN') LIMIT 1
+            )
+          WHERE (date_enrolled BETWEEN #{start_date} AND #{end_date})
+            AND date_enrolled != earliest_start_date #{site_manager(operator: 'AND', column: 'temp_earliest_start_date.site_id', location: @location)}
+            AND COALESCE(#{
+              if @adapter == 'mysql2'
+                <<~SQL
+                  TIMESTAMPDIFF(day,last_taken_art_obs.value_datetime,last_taken_art_obs.obs_datetime) <= 14
+                SQL
+              else
+                <<~SQL
+                  EXTRACT(DAY FROM AGE(last_taken_art_obs.obs_datetime::DATE, last_taken_art_obs.value_datetime::DATE)) <= 14
+                SQL
+              end
+            }, TRUE)
+            AND #{in_manager(column: 'temp_earliest_start_date.patient_id', values: re_initiated_on_art, negation: true)}
+          GROUP BY temp_earliest_start_date.patient_id;
+        SQL
+      end
+
+      def re_initiated_on_art(start_date, end_date)
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT temp_earliest_start_date.patient_id
+          FROM temp_earliest_start_date
+          INNER JOIN clinic_registration_encounter
+            ON temp_earliest_start_date.patient_id = clinic_registration_encounter.patient_id #{site_manager(operator: 'AND', column: 'clinic_registration_encounter.site_id', location: @location)}
+          INNER JOIN ever_registered_obs
+            ON clinic_registration_encounter.encounter_id = ever_registered_obs.encounter_id
+            AND ever_registered_obs.value_coded = (SELECT concept_id FROM concept_name
+              WHERE LOWER(name) = LOWER('Yes') AND voided = 0 LIMIT 1) #{site_manager(operator: 'AND', column: 'ever_registered_obs.site_id', location: @location)}
+          INNER JOIN (
+            SELECT person_id, MIN(obs_datetime) AS obs_datetime
+            FROM ever_registered_obs #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)}
+            GROUP BY person_id
+          ) AS max_ever_registered_obs
+            ON max_ever_registered_obs.person_id = ever_registered_obs.person_id
+            AND max_ever_registered_obs.obs_datetime = ever_registered_obs.obs_datetime
+          INNER JOIN obs AS last_taken_art_obs
+            ON last_taken_art_obs.encounter_id = clinic_registration_encounter.encounter_id
+            AND last_taken_art_obs.voided = 0 #{site_manager(operator: 'AND', column: 'last_taken_art_obs.site_id', location: @location)}
+            AND last_taken_art_obs.concept_id = (
+              SELECT concept_id FROM concept_name WHERE LOWER(name) = LOWER('DATE ART LAST TAKEN') LIMIT 1
+            )
+          WHERE (date_enrolled BETWEEN '#{start_date}' AND '#{end_date}')
+            AND #{timestampdiff_manager(date1: 'last_taken_art_obs.value_datetime', date2: 'last_taken_art_obs.obs_datetime', interval: 'day')} > 14
+            AND date_enrolled != earliest_start_date #{site_manager(operator: 'AND', column: 'temp_earliest_start_date.site_id', location: @location)}
+          GROUP BY temp_earliest_start_date.patient_id;
+        SQL
+      end
+
+      def initiated_on_art_first_time(start_date, end_date)
+        ActiveRecord::Base.connection.select_all(
+          "SELECT * FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}'
+            AND date_enrolled = earliest_start_date #{site_manager(operator: 'AND', column: 'site_id',
+                                                                   location: @location)}
+          GROUP BY patient_id"
+        )
+      end
+
+      def males_initiated_on_art_first_time(start_date, end_date, data)
+        clients = []
+        (data || []).each do |e|
+          gender = e['gender']&.upcase&.first
+          next if gender.blank?
+          next unless gender == 'M'
+
+          date_enrolled = e['date_enrolled'].to_date
+          start_date = start_date.to_date
+          end_date = end_date.to_date
+          date_enrolled >= start_date && date_enrolled <= end_date ? clients << e : next
+        end
+
+        clients
+      end
+
+      def get_cum_start_date
+        cum_start_date = ActiveRecord::Base.connection.select_value <<~SQL
+          SELECT MIN(date_enrolled) FROM temp_earliest_start_date #{site_manager(operator: 'WHERE', column: 'site_id', location: @location)}
+        SQL
+
+        begin
+          cum_start_date.to_date
+        rescue StandardError
+          nil
+        end
+      end
+
+      def total_registered(start_date, end_date)
+        ActiveRecord::Base.connection.select_all(
+          "SELECT * FROM temp_earliest_start_date
+          WHERE date_enrolled BETWEEN '#{start_date}' AND '#{end_date}' #{site_manager(operator: 'AND',
+                                                                                       column: 'site_id', location: @location)}
+          GROUP BY patient_id"
+        )
+      end
+
+      def load_tmp_patient_table(_cohort_struct)
+        create_tmp_patient_table
+        #         arv_orders.each_with_object({}) do |order, patient_tab|
+        #           next if patient_tab.include?(order.patient_id)
+        #
+        #           person = ::Person.find(order.patient_id)
+        #           next unless person.birthdate # && patient_in_program?(person.patient)
+        #
+        #           add_patient_record(person, order, cohort_struct)
+        #
+        #           patient_tab[order.patient_id] = person
+        #         end
+      end
+
+      def create_tmp_patient_table_2(_end_date)
+        ##########################################################
+        ActiveRecord::Base.connection.execute <<~SQL
+          DROP FUNCTION IF EXISTS patient_date_enrolled;
+        SQL
+
+        ::Drug.arv_drugs.map(&:concept_id)
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE FUNCTION patient_date_enrolled(my_patient_id int) RETURNS DATE
+          DETERMINISTIC
+          BEGIN
+          DECLARE my_start_date DATE;
+          DECLARE min_start_date DATETIME;
+          DECLARE arv_concept_id INT(11);
+
+          SET arv_concept_id = (SELECT concept_id FROM concept_name WHERE name ='ANTIRETROVIRAL DRUGS' LIMIT 1);
+
+          SET my_start_date = (SELECT DATE(o.start_date) FROM drug_order d INNER JOIN orders o ON d.order_id = o.order_id AND o.voided = 0 WHERE o.patient_id = my_patient_id AND drug_inventory_id IN(SELECT drug_id FROM drug WHERE concept_id IN(SELECT concept_id FROM concept_set WHERE concept_set = arv_concept_id)) AND d.quantity > 0 AND o.start_date = (SELECT min(start_date) FROM drug_order d INNER JOIN orders o ON d.order_id = o.order_id AND o.voided = 0 WHERE d.quantity > 0 AND o.patient_id = my_patient_id AND drug_inventory_id IN(SELECT drug_id FROM drug WHERE concept_id IN(SELECT concept_id FROM concept_set WHERE concept_set = arv_concept_id))) LIMIT 1);
+
+
+          RETURN my_start_date;
+          END;
+        SQL
+        ##########################################################
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          DROP TABLE IF EXISTS `temp_earliest_start_date`;
+        SQL
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE TABLE temp_earliest_start_date
+            select
+                `p`.`patient_id` AS `patient_id`,
+                `pe`.`gender` AS `gender`,
+                `pe`.`birthdate`,
+                date_antiretrovirals_started(`p`.`patient_id`, min(`s`.`start_date`)) AS `earliest_start_date`,
+                cast(patient_date_enrolled(`p`.`patient_id`) as date) AS `date_enrolled`,
+                `person`.`death_date` AS `death_date`,
+                (select timestampdiff(year, `pe`.`birthdate`, min(`s`.`start_date`))) AS `age_at_initiation`,
+                (select timestampdiff(day, `pe`.`birthdate`, min(`s`.`start_date`))) AS `age_in_days`
+            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))
+            group by `p`.`patient_id`;
+        SQL
+      end
+
+      def arv_orders
+        ::Order.joins(:drug_order).where(
+          'drug_order.drug_inventory_id in (?)', ::Drug.arv_drugs.collect(&:drug_id)
+        ).order(:start_date)
+      end
+
+      def add_patient_record(person, order, cohort_struct)
+        date_enrolled = order.start_date.to_date
+        art_earliest_start_date = patient_earliest_start_date(order.patient_id, date_enrolled)
+
+        if date_enrolled == art_earliest_start_date
+          cohort_struct.cum_initiated_on_art_first_time ||= 0
+          cohort_struct.cum_initiated_on_art_first_time += 1
+        end
+
+        age_in_months_when_starting = (art_earliest_start_date - person.birthdate).to_i
+        age_when_starting = (age_in_months_when_starting / 365).to_i
+        deathdate = person.death_date ? "'#{person.death_date.to_date}'" : 'NULL'
+
+        ActiveRecord::Base.connection.execute(
+          "INSERT INTO temp_earliest_start_date (
+              patient_id,
+              date_enrolled,
+              earliest_start_date,
+              gender,
+              birthdate,
+              birthdate_estimated,
+              death_date,
+              age_at_initiation,
+              age_in_days
+           ) VALUES (
+              #{order.patient_id},
+              '#{order.start_date.to_date}',
+              '#{art_earliest_start_date.to_date}',
+              '#{person.gender}',
+              '#{person.birthdate}',
+              '#{person.birthdate_estimated}',
+              #{deathdate},
+              '#{age_when_starting}',
+              '#{age_in_months_when_starting}'
+           )"
+        )
+      end
+
+      # Retrieve the earliest (clinic?) start date for a patient
+      def patient_earliest_start_date(patient_id, min_start_date)
+        result = ActiveRecord::Base.connection.select_one(
+          "SELECT date_antiretrovirals_started(
+            #{patient_id}, '#{min_start_date.to_date}'
+           ) AS date"
+        )
+        result['date'].to_date
+      end
+
+      # Returns a list of reasons for starting ART for each patient.
+      def patients_art_start_reason(patient_ids)
+        ActiveRecord::Base.connection.execute(
+          "SELECT person_id as patient_id, name, obs_datetime
+           FROM reason_for_art_eligibility_obs
+           WHERE #{in_manager(column: 'person_id',
+                              values: patient_ids)} #{site_manager(operator: 'AND',
+                                                                   column: 'reason_for_art_eligibility_obs.site_id', location: @location)}"
+        )
+      end
+
+      def patient_death_date(patient)
+        ::PatientState.find_by(program: program('HIV PROGRAM'), patient:)
+      end
+
+      # Filter out patients with given start causes from patient_ids
+      def filter_patients_with_start_cause(patient_ids, start_cause_concept_ids)
+        obs_concepts = start_cause_concept_ids.push(concept('WHO STAGES CRITERIA PRESENT').concept_id)
+        obs_values = start_cause_concept_ids.push(concept('YES').concept_id)
+
+        ActiveRecord::Base.connection.execute(
+          "SELECT *
+          FROM hiv_staging_conditions_obs
+           WHERE #{in_manager(column: 'concept_id', values: obs_concepts)}
+            AND #{in_manager(column: 'value_coded', values: obs_values)}
+            AND #{in_manager(column: 'person_id',
+                             values: patient_ids)} #{site_manager(operator: 'AND',
+                                                                  column: 'hiv_staging_conditions_obs.site_id', location: @location)}
+           GROUP BY person_id"
+        )
+      end
+
+      def patient_in_program?(patient)
+        return false unless patient
+
+        pprogram = ::PatientProgram.find_by(program: program('HIV PROGRAM'), patient:)
+        return false unless pprogram
+
+        ::PatientState.where(patient_program: pprogram, state: 7).exists?
+      end
+    end
+  end
+end
+# rubocop:enable Metrics/ClassLength