malawi_hiv_program_reports 1.0.1 → 1.0.3

data/app/services/malawi_hiv_program_reports/pepfar/tx_ml.rb

@@ -0,0 +1,181 @@
+# frozen_string_literal: true
+
+module MalawiHivProgramReports
+  module Pepfar
+    class TxMl
+      attr_reader :start_date, :end_date, :location
+
+      include Utils
+      include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+      include MalawiHivProgramReports::Adapters::Moh::Custom
+
+      def initialize(start_date:, end_date:, **kwargs)
+        @start_date = start_date.to_date.strftime('%Y-%m-%d 00:00:00')
+        @end_date = end_date.to_date.strftime('%Y-%m-%d 23:59:59')
+        @occupation = kwargs[:occupation]
+        @location = kwargs[:location]
+        @adapter = ActiveRecord::Base.connection.adapter_name.downcase
+      end
+
+      def find_report
+        tx_ml
+      end
+
+      private
+
+      def tx_ml
+        data = {}
+        tx_curr = potential_tx_ml_clients
+        tx_new  = new_potential_tx_ml_clients
+        patient_ids = []
+        earliest_start_dates = {}
+
+        (tx_curr || []).each do |pat|
+          patient_id = pat['patient_id'].to_i
+          patient_ids << patient_id
+          earliest_start_dates[patient_id] = begin
+            pat['earliest_start_date'].to_date
+          rescue StandardError
+            pat['date_enrolled'].to_date
+          end
+        end
+
+        (tx_new || []).each do |pat|
+          patient_id = pat['patient_id'].to_i
+          patient_ids << patient_id
+          patient_ids = patient_ids.uniq
+          earliest_start_dates[patient_id] = begin
+            pat['earliest_start_date'].to_date
+          rescue StandardError
+            pat['date_enrolled'].to_date
+          end
+          patient_ids << pat['patient_id']
+          patient_ids = patient_ids.uniq
+        end
+
+        return [] if patient_ids.blank?
+
+        filtered_patients = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT
+            p.person_id patient_id, birthdate, gender,
+            #{function_manager(function: 'pepfar_patient_outcome', location: @location, args: "p.person_id::int, '#{end_date.to_date}'::date, #{@location}::int")} outcome,
+            #{function_manager(function: 'disaggregated_age_group', location: @location, args: "p.birthdate::date, '#{end_date.to_date}::date'")} age_group
+          FROM person p
+          WHERE #{in_manager(column: 'p.person_id', values: patient_ids)}
+          #{site_manager(operator: 'AND', column: 'p.site_id', location: @location)}
+          GROUP BY p.person_id #{group_by_columns('p.birthdate, p.gender')}
+        SQL
+
+        (filtered_patients || []).each do |pat|
+          outcome = pat['outcome']
+          next if outcome == 'On antiretrovirals'
+
+          patient_id = pat['patient_id'].to_i
+          gender = begin
+            pat['gender'].first.upcase
+          rescue StandardError
+            'Unknown'
+          end
+          age_group = pat['age_group']
+
+          if data[age_group].blank?
+            data[age_group] = {}
+            data[age_group][gender] = [[], [], [], [], [], []]
+          elsif data[age_group][gender].blank?
+            data[age_group][gender] = [[], [], [], [], [], []]
+          end
+
+          case outcome
+          when 'Defaulted'
+            def_months = defaulter_period(patient_id, earliest_start_dates[patient_id])
+            if def_months < 3
+              data[age_group][gender][1] << patient_id
+            elsif def_months <= 5
+              data[age_group][gender][2] << patient_id
+            elsif def_months > 5
+              data[age_group][gender][3] << patient_id
+            end
+          when 'Patient died'
+            data[age_group][gender][0] << patient_id
+          when /Stopped/i
+            data[age_group][gender][5] << patient_id
+          when 'Patient transferred out'
+            data[age_group][gender][4] << patient_id
+          end
+        rescue StandardError => e
+          Rails.logger.error(e.message)
+        end
+
+        data
+      end
+
+      def potential_tx_ml_clients
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT
+            p.patient_id AS patient_id,
+            pe.birthdate,
+            pe.gender,
+            #{function_manager(function: 'patient_date_enrolled', location: @location, args: "p.patient_id::int, #{@location}::int")} AS date_enrolled,
+            #{function_manager(function: 'date_antiretrovirals_started', location: @location, args: "p.patient_id::int, MIN(s.start_date)::date, #{@location}::int")} AS earliest_start_date
+          FROM patient_program p
+            INNER JOIN person pe ON pe.person_id = p.patient_id AND pe.voided = 0
+            #{site_manager(operator: 'AND', column: 'pe.site_id', location: @location)}
+            INNER JOIN patient_state s ON p.patient_program_id = s.patient_program_id AND s.voided = 0 AND s.state = 7
+            #{site_manager(operator: 'AND', column: 's.site_id', location: @location)}
+            LEFT JOIN (#{current_occupation_query}) a ON a.person_id = p.patient_id
+            WHERE p.program_id = 1 #{%w[Military Civilian].include?(@occupation) ? 'AND' : ''} #{occupation_filter(occupation: @occupation, field_name: 'value', table_name: 'a', include_clause: false)}
+              AND DATE(s.start_date) < '#{start_date.to_date}'
+              #{site_manager(operator: 'AND', column: 'p.site_id', location: @location)}
+              AND #{function_manager(function: 'pepfar_patient_outcome', location: @location, args: "p.patient_id::int, '#{start_date.to_date}'::date, #{@location}::int")} = 'On antiretrovirals'
+              AND pe.person_id NOT IN (#{drug_refills_and_external_consultation_list})
+            GROUP BY p.patient_id
+            HAVING date_enrolled IS NOT NULL AND DATE(date_enrolled) < '#{start_date.to_date}';
+        SQL
+      end
+
+      def new_potential_tx_ml_clients
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT
+            p.patient_id AS patient_id,
+            pe.birthdate,
+            pe.gender,
+            #{function_manager(function: 'patient_date_enrolled', location: @location, args: "p.patient_id::int, #{@location}::int")} AS date_enrolled,
+            #{function_manager(function: 'date_antiretrovirals_started', location: @location, args: "p.patient_id::int, MIN(s.start_date)::date, #{@location}::int")} AS earliest_start_date
+          FROM patient_program p
+            INNER JOIN person pe ON pe.person_id = p.patient_id AND pe.voided = 0
+            #{site_manager(operator: 'AND', column: 'pe.site_id', location: @location)}
+            INNER JOIN patient_state s ON p.patient_program_id = s.patient_program_id AND s.voided = 0 AND s.state = 7
+            #{site_manager(operator: 'AND', column: 's.site_id', location: @location)}
+            LEFT JOIN (#{current_occupation_query}) a ON a.person_id = p.patient_id
+            WHERE p.program_id = 1 #{%w[Military Civilian].include?(@occupation) ? 'AND' : ''} #{occupation_filter(occupation: @occupation, field_name: 'value', table_name: 'a', include_clause: false)}
+              AND DATE(s.start_date) BETWEEN DATE('#{start_date}') AND DATE('#{end_date}')
+              AND pe.person_id NOT IN (#{drug_refills_and_external_consultation_list})
+            #{site_manager(operator: 'AND', column: 'p.site_id', location: @location)}
+            GROUP BY p.patient_id
+            HAVING date_enrolled IS NOT NULL AND date_enrolled BETWEEN DATE('#{start_date}') AND DATE('#{end_date}');
+        SQL
+      end
+
+      def defaulter_period(patient_id, earliest_start_date)
+        defaulter_date = ActiveRecord::Base.connection.select_one <<~SQL
+          SELECT #{function_manager(function: 'current_pepfar_defaulter_date', location: @location, args: "#{patient_id}::int, '#{end_date}'::date, #{@location}::int")}
+        SQL
+
+        defaulter_date = begin
+          defaulter_date['def_date'].to_date
+        rescue StandardError
+          end_date.to_date
+        end
+
+        raise 'Defaulted outside the reporting period' if defaulter_date > end_date.to_date
+        raise 'Defaulted outside the reporting period' if defaulter_date < start_date.to_date
+
+        days_gone = ActiveRecord::Base.connection.select_one <<~SQL
+          SELECT TIMESTAMPDIFF(MONTH, DATE('#{earliest_start_date}'), DATE('#{defaulter_date}')) months;
+        SQL
+
+        days_gone['months'].to_i
+      end
+    end
+  end
+end

data/app/services/malawi_hiv_program_reports/pepfar/tx_new.rb

@@ -0,0 +1,205 @@
+# frozen_string_literal: true
+
+module MalawiHivProgramReports
+  module Pepfar
+    # This class is responsible for generating the tx_new report
+    # rubocop:disable Metrics/ClassLength
+    class TxNew
+      include MalawiHivProgramReports::Utils::ModelUtils
+      include Pepfar::Utils
+      include MalawiHivProgramReports::Adapters::Moh::Custom
+
+      attr_reader :start_date, :end_date, :rebuild, :location
+
+      def initialize(start_date:, end_date:, **kwargs)
+        @start_date = start_date.to_date.beginning_of_day.strftime('%Y-%m-%d %H:%M:%S')
+        @end_date = end_date.to_date.end_of_day.strftime('%Y-%m-%d %H:%M:%S')
+        rebuild_string = kwargs[:rebuild]
+        @rebuild = rebuild_string.present? ? rebuild_string&.downcase == 'true' : false
+        @location = kwargs[:location]
+      end
+
+      def find_report
+        report = init_report
+        addittional_groups report
+        if rebuild
+          MalawiHivProgramReports::Moh::CohortBuilder.new(location: @location).init_temporary_tables(start_date,
+                                                                                                     end_date, '')
+        end
+        process_data report
+        flatten_the_report report
+      rescue StandardError => e
+        Rails.logger.error e.message
+        Rails.logger.error e.backtrace.join("\n")
+
+        raise e
+      end
+
+      private
+
+      GENDER = %w[M F].freeze
+
+      def init_report
+        pepfar_age_groups.each_with_object({}) do |age_group, report|
+          report[age_group] = GENDER.each_with_object({}) do |gender, age_group_report|
+            age_group_report[gender] = {
+              cd4_less_than_200: [],
+              cd4_greater_than_equal_to_200: [],
+              cd4_unknown_or_not_done: [],
+              transfer_in: []
+            }
+          end
+        end
+      end
+
+      def addittional_groups(report)
+        report['All'] = {}
+        %w[Male FP FNP FBf].each do |key|
+          report['All'][key] = {
+            cd4_less_than_200: [],
+            cd4_greater_than_equal_to_200: [],
+            cd4_unknown_or_not_done: [],
+            transfer_in: []
+          }
+        end
+      end
+
+      def process_data(report)
+        data.each do |row|
+          age_group = row['age_group']
+          gender = row['gender']
+          date_enrolled = row['date_enrolled']
+          next if age_group.blank?
+          next if gender.blank?
+          next unless GENDER.include?(gender)
+          next unless pepfar_age_groups.include?(age_group)
+
+          cd4_count_group = row['cd4_count_group']
+          new_patient = row['new_patient'].to_i
+          patient_id = row['patient_id'].to_i
+          earliest_start_date = row['earliest_start_date']
+          indicator = new_patient.positive? ? cd4_count_group : 'transfer_in'
+
+          if new_patient.positive? && earliest_start_date.to_date >= start_date.to_date
+            report[age_group.to_s][gender.to_s][indicator.to_sym] << patient_id
+          elsif new_patient.zero?
+            report[age_group.to_s][gender.to_s][indicator.to_sym] << patient_id
+          else
+            next
+          end
+          process_aggreggation_rows(report:, gender:, indicator:, start_date: date_enrolled,
+                                    patient_id:, maternal_status: row['maternal_status'], maternal_status_date: row['maternal_status_date'])
+        end
+      end
+
+      def process_aggreggation_rows(report:, gender:, indicator:, start_date:, **kwargs)
+        maternal_status = kwargs[:maternal_status]
+        maternal_status_date = kwargs[:maternal_status_date]
+
+        if gender == 'M'
+          report['All']['Male'][indicator.to_sym] << kwargs[:patient_id]
+        elsif maternal_status&.match?(/pregnant/i) && (maternal_status_date&.to_date&.<= start_date.to_date)
+          report['All']['FP'][indicator.to_sym] << kwargs[:patient_id]
+        elsif maternal_status&.match?(/breast/i) && (maternal_status_date&.to_date&.<= start_date.to_date)
+          report['All']['FBf'][indicator.to_sym] << kwargs[:patient_id]
+        else
+          report['All']['FNP'][indicator.to_sym] << kwargs[:patient_id]
+        end
+      end
+
+      def process_age_group_report(age_group, gender, age_group_report)
+        {
+          age_group:,
+          gender: if gender == 'F'
+                    'Female'
+                  else
+                    (gender == 'M' ? 'Male' : gender)
+                  end,
+          cd4_less_than_200: age_group_report[:cd4_less_than_200],
+          cd4_greater_than_equal_to_200: age_group_report[:cd4_greater_than_equal_to_200],
+          cd4_unknown_or_not_done: age_group_report[:cd4_unknown_or_not_done],
+          transfer_in: age_group_report[:transfer_in]
+        }
+      end
+
+      def flatten_the_report(report)
+        result = []
+        report.each do |age_group, age_group_report|
+          age_group_report.each_key do |gender|
+            result << process_age_group_report(age_group, gender, age_group_report[gender])
+          end
+        end
+
+        new_group = pepfar_age_groups.map { |age_group| age_group }
+        new_group << 'All'
+        gender_scores = { 'Female' => 0, 'Male' => 1, 'FNP' => 3, 'FP' => 2, 'FBf' => 4 }
+        result_scores = result.sort_by do |item|
+          gender_score = gender_scores[item[:gender]]
+          age_group_score = new_group.index(item[:age_group])
+          [gender_score, age_group_score]
+        end
+        # remove all unknown age groups
+        result_scores.reject { |item| item[:age_group].match?(/unknown/i) }
+      end
+
+      def data
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT
+            pp.patient_id,
+            MIN(pp.gender) gender,
+            disaggregated_age_group(pp.birthdate, DATE('#{end_date}')) age_group,
+            CASE
+              WHEN o.value_numeric < 200 THEN 'cd4_less_than_200'
+              WHEN o.value_numeric = 200 AND o.value_modifier = '=' THEN 'cd4_greater_than_equal_to_200'
+              WHEN o.value_numeric = 200 AND o.value_modifier = '<' THEN 'cd4_less_than_200'
+              WHEN o.value_numeric = 200 AND o.value_modifier = '>' THEN 'cd4_greater_than_equal_to_200'
+              WHEN o.value_numeric > 200 THEN 'cd4_greater_than_equal_to_200'
+              ELSE 'cd4_unknown_or_not_done'
+            END cd4_count_group,
+            CASE
+              WHEN transfer_in.value_coded IS NOT NULL THEN 0
+              ELSE 1
+            END new_patient,
+            pp.date_enrolled,
+            pp.earliest_start_date,
+            preg_or_breast.name AS maternal_status,
+            DATE(MIN(pregnant_or_breastfeeding.obs_datetime)) AS maternal_status_date
+          FROM temp_earliest_start_date pp
+          INNER JOIN person pe ON pe.person_id = pp.patient_id AND pe.voided = 0
+          #{site_manager(operator: 'AND', column: 'pe.site_id', location: @location)}
+          LEFT JOIN (
+            SELECT max(o.obs_datetime) AS obs_datetime, o.person_id
+            FROM obs o
+            INNER JOIN concept_name cn ON cn.concept_id = o.concept_id AND cn.name = 'CD4 count' AND cn.voided = 0
+            INNER JOIN patient_program pp ON pp.patient_id = o.person_id
+                AND pp.program_id = #{program('HIV PROGRAM').id}
+                AND pp.voided = 0
+            INNER JOIN patient_state ps ON ps.patient_program_id = pp.patient_program_id AND ps.voided = 0 AND ps.state = 7 AND ps.start_date <= DATE('#{end_date}')
+            WHERE o.concept_id = #{concept_name('CD4 count').concept_id} AND o.voided = 0
+            #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}#{'            '}
+            AND o.obs_datetime <= '#{end_date}' AND o.obs_datetime >= '#{start_date}'
+            GROUP BY o.person_id
+          ) current_cd4 ON current_cd4.person_id = pp.patient_id
+          LEFT JOIN obs o ON o.person_id = pp.patient_id AND o.concept_id = #{concept_name('CD4 count').concept_id} AND o.voided = 0 AND o.obs_datetime = current_cd4.obs_datetime
+          #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+          LEFT JOIN obs transfer_in ON transfer_in.person_id = pp.patient_id
+            AND transfer_in.concept_id = #{concept_name('Ever registered at ART clinic').concept_id}
+            AND transfer_in.voided = 0
+            AND transfer_in.value_coded = #{concept_name('Yes').concept_id}
+            AND transfer_in.obs_datetime <= '#{end_date}'
+            AND transfer_in.obs_datetime >= '#{start_date}'
+            #{site_manager(operator: 'AND', column: 'transfer_in.site_id', location: @location)}
+          LEFT JOIN obs pregnant_or_breastfeeding ON pregnant_or_breastfeeding.person_id = pp.patient_id
+            AND pregnant_or_breastfeeding.concept_id IN (SELECT concept_id FROM concept_name WHERE name IN ('Breast feeding?', 'Breast feeding', 'Breastfeeding', 'Is patient pregnant?', 'patient pregnant') AND voided = 0)
+            AND pregnant_or_breastfeeding.voided = 0
+            AND pregnant_or_breastfeeding.value_coded = #{concept_name('Yes').concept_id}
+            #{site_manager(operator: 'AND', column: 'pregnant_or_breastfeeding.site_id', location: @location)}
+            LEFT JOIN concept_name preg_or_breast ON preg_or_breast.concept_id = pregnant_or_breastfeeding.concept_id AND preg_or_breast.voided = 0
+          WHERE pp.date_enrolled <= '#{end_date}' AND pp.date_enrolled >= '#{start_date}'
+          GROUP BY pp.patient_id
+        SQL
+      end
+    end
+    # rubocop:enable Metrics/ClassLength
+  end
+end

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

@@ -0,0 +1,288 @@
+# frozen_string_literal: true
+module MalawiHivProgramReports
+  module Pepfar
+    class TxRtt
+
+        include Utils
+        include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+        include MalawiHivProgramReports::Adapters::Moh::Custom
+        include MalawiHivProgramReports::Utils::ModelUtils
+        attr_reader :start_date, :end_date, :location
+
+        def initialize(start_date:, end_date:, **kwargs)
+          @start_date = ActiveRecord::Base.connection.quote(start_date.to_date.beginning_of_day.strftime('%Y-%m-%d %H:%M:%S'))
+          @end_date = ActiveRecord::Base.connection.quote(end_date.to_date.end_of_day.strftime('%Y-%m-%d %H:%M:%S'))
+          @occupation = kwargs[:occupation]
+          @location = kwargs[:location]
+        end
+
+        def find_report
+          process_report
+        end
+
+        def data
+          process_report
+        rescue StandardError => e
+          Rails.logger.error "Error running TX_RTT Report: #{e}"
+          Rails.logger.error e.backtrace.join("\n")
+          raise e
+        end
+
+        private
+
+        GENDER = %w[M F].freeze
+
+        def init_report
+          pepfar_age_groups.each_with_object({}) do |age_group, age_group_report|
+            age_group_report[age_group] = GENDER.each_with_object({}) do |gender, gender_report|
+              gender_report[gender] = indicators
+            end
+          end
+        end
+
+        def process_report
+          report = init_report
+          process_data report
+          flatten_the_report report
+        end
+
+        def process_data(report)
+          tx_rtt.each do |row|
+            age_group = row['age_group']
+            gender = row['gender']
+            months = row['months']
+            patient_id = row['patient_id']
+            cd4_cat = row['cd4_count_group']
+
+            next unless GENDER.include?(gender)
+            next unless pepfar_age_groups.include?(age_group)
+
+            cat = report[age_group][gender]
+            process_months(cat, months, patient_id)
+            process_cd4(cat, months, patient_id, cd4_cat)
+          end
+        end
+
+        def process_months(report, months, patient_id)
+          report[:returned_less_than_3_months] << patient_id if months.blank?
+          report[:returned_less_than_3_months] << patient_id if months < 3
+          report[:returned_greater_than_3_months_and_less_than_6_months] << patient_id if months >= 3 && months < 6
+          report[:returned_greater_than_or_equal_to_6_months] << patient_id if months >= 6
+        end
+
+        def process_cd4(report, months, patient_id, cd4_cat)
+          if cd4_cat == 'unknown_cd4_count' && months <= 2
+            report[:not_eligible_for_cd4] << patient_id
+            return
+          end
+
+          report[cd4_cat.to_sym] << patient_id
+        end
+
+        def indicators
+          {
+            'cd4_less_than_200': [],
+            'cd4_greater_than_or_equal_to_200': [],
+            'unknown_cd4_count': [],
+            'not_eligible_for_cd4': [],
+            'returned_less_than_3_months': [],
+            'returned_greater_than_3_months_and_less_than_6_months': [],
+            'returned_greater_than_or_equal_to_6_months': []
+          }
+        end
+
+        def process_age_group_report(age_group, gender, age_group_report)
+          {
+            age_group: age_group,
+            gender: gender,
+            cd4_less_than_200: age_group_report[:cd4_less_than_200],
+            cd4_greater_than_or_equal_to_200: age_group_report[:cd4_greater_than_or_equal_to_200],
+            unknown_cd4_count: age_group_report[:unknown_cd4_count],
+            not_eligible_for_cd4: age_group_report[:not_eligible_for_cd4],
+            returned_less_than_3_months: age_group_report[:returned_less_than_3_months],
+            returned_greater_than_3_months_and_less_than_6_months: age_group_report[:returned_greater_than_3_months_and_less_than_6_months],
+            returned_greater_than_or_equal_to_6_months: age_group_report[:returned_greater_than_or_equal_to_6_months]
+          }
+        end
+
+        def flatten_the_report(report)
+          result = []
+          report.each do |age_group, age_group_report|
+            result << process_age_group_report(age_group, 'M', age_group_report['M'])
+            result << process_age_group_report(age_group, 'F', age_group_report['F'])
+          end
+          sorted_results = result.sort_by do |item|
+            gender_score = item[:gender] == 'Female' ? 0 : 1
+            age_group_score = pepfar_age_groups.index(item[:age_group])
+            [gender_score, age_group_score]
+          end
+          # sort by gender, start all females and push all males to the end
+          sorted_results.sort_by { |h| [h[:gender] == 'F' ? 0 : 1] }
+        end
+
+        def tx_rtt
+          ActiveRecord::Base.connection.select_all <<~SQL
+             SELECT patient_program.patient_id,
+            #{function_manager(function: 'disaggregated_age_group', location: @location, args: "person.birthdate::date, #{@end_date}::date")} AS age_group,
+            person.gender,
+            IF(
+              patient_state_at_start_of_quarter.state = 6, 'Treatment stopped',
+              IF(
+                patient_state_at_start_of_quarter.state = 12, 'Defaulted',
+                #{function_manager(function: 'pepfar_patient_outcome', location: @location, args: "patient_program.patient_id, (DATE(#{@start_date}) - INTERVAL 1 DAY), #{@location}")}
+              )
+            ) AS initial_outcome,
+            IF(
+              patient_state_at_start_of_quarter.state = 6,
+              patient_state_at_start_of_quarter.start_date,
+              IF(
+                patient_state_at_start_of_quarter.state = 12,
+                patient_state_at_start_of_quarter.start_date,
+                #{function_manager(function: 'current_pepfar_defaulter_date', location: @location, args: "patient_program.patient_id, (DATE(#{@start_date}) - INTERVAL 1 DAY), #{@location}")} 
+                )) AS initial_outcome_date,
+              IF(
+                patients_with_orders_at_end_of_quarter.patient_id IS NOT NULL,  'On antiretrovirals',
+                IF(
+                  #{function_manager(function: 'current_pepfar_defaulter', location: @location, args: "patient_program.patient_id, #{@end_date}, #{@location}")} = 0,
+                  'On antiretrovirals','Defaulted'
+              )
+            ) AS final_outcome,
+            TIMESTAMPDIFF(MONTH, IF(
+              patient_state_at_start_of_quarter.state = 6,
+              patient_state_at_start_of_quarter.start_date,
+              IF(
+                patient_state_at_start_of_quarter.state = 12,
+                patient_state_at_start_of_quarter.start_date,
+                #{function_manager(function: 'current_pepfar_defaulter_date', location: @location, args: "patient_program.patient_id, (DATE(#{@start_date}) - INTERVAL 1 DAY), #{@location}")})
+            ), patients_who_received_art_in_quarter.start_date) AS months,
+                CASE
+                    WHEN cd4_result.value_numeric < 200 THEN 'cd4_less_than_200'
+                    WHEN cd4_result.value_numeric = 200 AND cd4_result.value_modifier = '=' THEN 'cd4_greater_than_or_equal_to_200'
+                    WHEN cd4_result.value_numeric = 200 AND cd4_result.value_modifier = '<' THEN 'cd4_less_than_200'
+                    WHEN cd4_result.value_numeric = 200 AND cd4_result.value_modifier = '>' THEN 'cd4_greater_than_or_equal_to_200'
+                    WHEN cd4_result.value_numeric > 200 THEN 'cd4_greater_than_or_equal_to_200'
+                    ELSE 'unknown_cd4_count'
+                END cd4_count_group
+            FROM patient_program
+            INNER JOIN person ON person.person_id = patient_program.patient_id
+            #{site_manager(operator: 'AND', column: 'person.site_id', location: @location)}
+            /* Select patients that were on treatment before start of reporting period */
+            INNER JOIN patient_state AS patient_ever_on_treatment
+              ON patient_ever_on_treatment.patient_program_id = patient_program.patient_program_id
+              AND patient_ever_on_treatment.state = 7
+              AND patient_ever_on_treatment.start_date < DATE(#{start_date})
+              AND patient_ever_on_treatment.voided = 0
+            /* Get patient's state at the start of the quarter. */
+            INNER JOIN (
+              SELECT patient_program_id, MAX(patient_state.date_created) AS date_created
+              FROM patient_state
+              INNER JOIN patient_program USING (patient_program_id)
+              WHERE patient_state.voided = 0
+                AND patient_program.voided = 0
+                AND patient_program.program_id = 1
+                AND patient_state.start_date < DATE(#{start_date}) + INTERVAL 1 DAY
+              GROUP BY patient_program_id
+            ) AS date_of_last_patient_state_before_quarter
+              ON date_of_last_patient_state_before_quarter.patient_program_id = patient_program.patient_program_id
+            LEFT JOIN patient_state AS patient_state_at_start_of_quarter
+              ON patient_state_at_start_of_quarter.patient_program_id = date_of_last_patient_state_before_quarter.patient_program_id
+              #{site_manager(operator: 'AND', column: 'patient_state_at_start_of_quarter.site_id', location: @location)}
+              AND patient_state_at_start_of_quarter.date_created = date_of_last_patient_state_before_quarter.date_created
+              AND patient_state_at_start_of_quarter.state IN (6, 12) /* 2: TO, 6: Tx Stopped, 12: Defaulted */
+            /* Select patients who received ART within the reporting period. */
+            INNER JOIN (
+              SELECT DISTINCT encounter.patient_id, orders.start_date
+              FROM encounter
+              INNER JOIN orders
+                ON orders.encounter_id = encounter.encounter_id
+                AND DATE(orders.start_date) BETWEEN DATE(#{start_date}) AND DATE(#{end_date})
+                AND orders.voided = 0
+              INNER JOIN drug_order
+                ON drug_order.order_id = orders.order_id
+                AND drug_order.quantity > 0
+                AND drug_order.drug_inventory_id IN (SELECT DISTINCT drug_id FROM arv_drug)
+              WHERE encounter.voided = 0
+                AND encounter.program_id = 1
+                AND DATE(encounter.encounter_datetime) BETWEEN DATE(#{start_date}) AND DATE(#{end_date})
+            ) AS patients_who_received_art_in_quarter
+              ON patients_who_received_art_in_quarter.patient_id = patient_program.patient_id
+            /* Ensure that patients are on ART at the end of the quarter */
+            INNER JOIN (
+              SELECT patient_program_id, MAX(patient_state.date_created) AS date_created
+              FROM patient_state
+              INNER JOIN patient_program USING (patient_program_id)
+              WHERE patient_state.voided = 0
+                AND patient_program.voided = 0
+                AND patient_program.program_id = 1
+                AND patient_state.start_date < DATE(#{end_date}) + INTERVAL 1 DAY
+              GROUP BY patient_program_id
+            ) AS date_of_last_patient_state_in_quarter
+              ON date_of_last_patient_state_in_quarter.patient_program_id = patient_program.patient_program_id
+
+              /*Not sure why Walter had this section in but I believe its not neccessary*/
+              /*INNER JOIN patient_state AS patient_state_at_end_of_quarter
+              ON patient_state_at_end_of_quarter.patient_program_id = patient_program.patient_program_id
+              AND patient_state_at_end_of_quarter.date_created = date_of_last_patient_state_before_quarter.date_created
+              AND patient_state_at_end_of_quarter.state = 7*/
+
+            /* Select patient who had orders in the last 30 days of the reporting period.
+               This is to be used as a quick filter for patients who are definitely
+               'On ART' by the end of the reporting period. The rest will be filtered by
+               the current_defaulter function. */
+            LEFT JOIN (
+              SELECT DISTINCT encounter.patient_id
+              FROM encounter
+              INNER JOIN orders
+                ON orders.encounter_id = encounter.encounter_id
+                AND orders.voided = 0
+                #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)}
+                AND DATE(orders.start_date) BETWEEN DATE(#{start_date}) AND DATE(#{end_date})
+                AND DATE(orders.auto_expire_date) >= (DATE(#{end_date}) - INTERVAL 30 DAY)
+              INNER JOIN drug_order
+                ON drug_order.order_id = orders.order_id
+                AND drug_order.quantity > 0
+                AND drug_order.drug_inventory_id IN (SELECT DISTINCT drug_id FROM arv_drug)
+              WHERE encounter.program_id = 1
+                AND DATE(encounter.encounter_datetime) BETWEEN DATE(#{start_date}) AND DATE(#{end_date})
+                AND encounter.voided = 0
+            ) AS patients_with_orders_at_end_of_quarter
+              ON patients_with_orders_at_end_of_quarter.patient_id = patient_program.patient_id
+            LEFT JOIN (
+                SELECT max(o.obs_datetime) AS obs_datetime, o.person_id
+                FROM obs o
+                INNER JOIN concept_name cn ON cn.concept_id = o.concept_id AND cn.name = 'CD4 count'
+                #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+                WHERE o.concept_id = #{concept('CD4 count').concept_id} AND o.voided = 0
+                AND o.obs_datetime <= #{end_date} AND o.obs_datetime >= #{start_date}
+                GROUP BY o.person_id
+            ) current_cd4 ON current_cd4.person_id = patient_program.patient_id
+            LEFT JOIN obs cd4_result ON cd4_result.person_id = patient_program.patient_id AND cd4_result.concept_id = #{concept('CD4 count').concept_id} AND cd4_result.voided = 0
+            #{site_manager(operator: 'AND', column: 'cd4_result.site_id', location: @location)}
+            #  Not sure why we are matching the two dates but the result was excluding cd4 results for patients.
+            # AND cd4_result.obs_datetime = current_cd4.obs_datetime
+            LEFT JOIN (#{current_occupation_query}) a ON a.person_id = patient_program.patient_id
+            WHERE patient_program.program_id = 1 #{%w[Military Civilian].include?(@occupation) ? 'AND' : ''} #{occupation_filter(occupation: @occupation, field_name: 'value', table_name: 'a', include_clause: false)}
+            /* Ensure that the patients retrieved, did not receive ART within 28 days
+            before the start of the reporting period */
+              AND patient_program.patient_id NOT IN (
+                SELECT DISTINCT orders.patient_id
+                FROM orders
+                INNER JOIN drug_order USING (order_id)
+                INNER JOIN arv_drug ON arv_drug.drug_id = drug_inventory_id
+                INNER JOIN patient_program
+                  ON patient_program.patient_id = orders.patient_id
+                  AND patient_program.program_id = 1
+                   #{site_manager(operator: 'AND', column: 'orders.site_id', location: @location)}
+                WHERE ((DATE(orders.start_date )BETWEEN (DATE(#{start_date}) - INTERVAL 30 DAY) AND DATE(#{start_date}))
+                       OR (DATE(orders.auto_expire_date) BETWEEN (DATE(#{start_date}) - INTERVAL 30 DAY) AND DATE(#{start_date})))
+                  AND orders.voided = 0
+              )
+            GROUP BY patient_program.patient_id
+            HAVING initial_outcome IN ('Defaulted', 'Treatment stopped')
+               AND final_outcome = 'On antiretrovirals'
+               AND initial_outcome_date IS NOT NULL;
+          SQL
+        end
+      end
+    end
+  end