malawi_hiv_program_reports 1.0.1 → 1.0.3

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

@@ -0,0 +1,223 @@
+# frozen_string_literal: true
+
+module MalawiHivProgramReports
+  module Clinic
+    # Generates a hypertension report for a clinic
+    # rubocop:disable Metrics/ClassLength
+    class HypertensionReport
+      AGE_GROUPS = [
+        '20-24 years',
+        '25-29 years', '30-34 years',
+        '35-39 years', '40-44 years',
+        '45-49 years', '50-54 years',
+        '55-59 years', '60-64 years',
+        '65-69 years', '70-74 years',
+        '75-79 years', '80-84 years',
+        '85-89 years',
+        '90 plus years'
+      ].freeze
+
+      GENDER = %w[M F].freeze
+
+      DRUG_MAPPING = {
+        'Hydrochlorothiazide (25mg tablet)' => :hydrochlorothiazide_25mg,
+        'HCZ (25mg tablet)' => :hydrochlorothiazide_25mg,
+        'Hctz (25mg)' => :hydrochlorothiazide_25mg,
+        'Amlodipine (5mg tablet)' => :amlodipine_5mg,
+        'Amlodipine 5mg' => :amlodipine_5mg,
+        'Amlodipine (5mg)' => :amlodipine_5mg,
+        'Amlodipine (10mg tablet)' => :amlodipine_10mg,
+        'Enalapril (5mg tablet)' => :enalapril_5mg,
+        'Enalapril (5mg)' => :enalapril_5mg,
+        'Enalapril (10mg tablet)' => :enalapril_10mg,
+        'Enalapril (10mg)' => :enalapril_10mg,
+        'Atenolol (50mg tablet)' => :atenolol_50mg,
+        'Atenolol (50mg)' => :atenolol_50mg,
+        'Atenolol (100mg tablet)' => :atenolol_100mg
+      }.freeze
+
+      def initialize(start_date:, end_date:, **_kwargs)
+        @start_date = ActiveRecord::Base.connection.quote(start_date)
+        @end_date = ActiveRecord::Base.connection.quote(end_date)
+      end
+
+      def find_report
+        @report = init_report
+        process_data
+        @report
+      rescue StandardError => e
+        puts e.message
+        puts e.backtrace.join("\n")
+        raise e
+      end
+
+      private
+
+      def init_report
+        AGE_GROUPS.each_with_object({}) do |age_group, report|
+          report[age_group] = GENDER.each_with_object({}) do |gender, gender_sub_report|
+            gender_sub_report[gender] = initialize_gender_metrics
+          end
+        end
+      end
+
+      # rubocop:disable Metrics/MethodLength
+      def initialize_gender_metrics
+        {
+          screened: [],
+          normal_reading: [],
+          mild_reading: [],
+          moderate_reading: [],
+          severe_reading: [],
+          hydrochlorothiazide_25mg: [],
+          amlodipine_5mg: [],
+          amlodipine_10mg: [],
+          enalapril_5mg: [],
+          enalapril_10mg: [],
+          atenolol_50mg: [],
+          atenolol_100mg: [],
+          total_regimen: []
+        }
+      end
+      # rubocop:enable Metrics/MethodLength
+
+      # rubocop:disable Metrics/AbcSize
+      # rubocop:disable Metrics/MethodLength
+      def process_data
+        (data || []).each do |row|
+          age_group = row['age_group']
+          gender = row['gender']
+          next unless AGE_GROUPS.include?(age_group)
+          next unless GENDER.include?(gender)
+
+          patient = client_info(row)
+          cluster = @report[age_group][gender]
+          cluster[:screened] << patient
+          process_bp_classification(cluster, patient, row['systolic_classification'], row['diastolic_classification'])
+          process_drug_data(cluster, patient, row['drug_names'].split(',')) if row['drug_names'].present?
+          cluster[:total_regimen] << patient if row['drug_names'].present?
+        end
+      end
+      # rubocop:enable Metrics/AbcSize
+      # rubocop:enable Metrics/MethodLength
+
+      def process_bp_classification(cluster, patient_id, sys_class, dia_class)
+        classification = SEVERITY_ORDER[sys_class.to_sym] > SEVERITY_ORDER[dia_class.to_sym] ? sys_class : dia_class
+        case SEVERITY_CLASSIFICATION[classification.to_sym]
+        when 'NORMAL'
+          cluster[:normal_reading] << patient_id
+        when 'MILD'
+          cluster[:mild_reading] << patient_id
+        when 'MODERATE'
+          cluster[:moderate_reading] << patient_id
+        when 'SEVERE'
+          cluster[:severe_reading] << patient_id
+        end
+      end
+
+      def process_drug_data(cluster, patient_id, drugs)
+        return if drugs.blank?
+
+        drugs.each do |drug|
+          cluster_key = DRUG_MAPPING[drug]
+          cluster[cluster_key] << patient_id if cluster_key
+        end
+      end
+
+      SEVERITY_ORDER = {
+        severe_reading: 4,
+        moderate_reading: 3,
+        mild_reading: 2,
+        normal_reading: 1
+      }.freeze
+
+      SEVERITY_CLASSIFICATION = {
+        severe_reading: 'SEVERE',
+        moderate_reading: 'MODERATE',
+        mild_reading: 'MILD',
+        normal_reading: 'NORMAL'
+      }.freeze
+
+      def data
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT
+              tpo.patient_id,
+              sys.value_numeric systolic,
+              dia.value_numeric diastolic,
+              CASE
+                  WHEN sys.value_numeric <= 139 THEN 'normal_reading'
+                  WHEN sys.value_numeric > 139 AND sys.value_numeric <= 159 THEN 'mild_reading'
+                  WHEN sys.value_numeric > 159 AND sys.value_numeric <= 179 THEN 'moderate_reading'
+                  WHEN sys.value_numeric > 179 THEN 'severe_reading'
+              END AS systolic_classification,
+              CASE
+                  WHEN dia.value_numeric <= 89 THEN 'normal_reading'
+                  WHEN dia.value_numeric > 89 AND dia.value_numeric <= 99 THEN 'mild_reading'
+                  WHEN dia.value_numeric > 99 AND dia.value_numeric <= 109 THEN 'moderate_reading'
+                  WHEN dia.value_numeric > 109 THEN 'severe_reading'
+              END AS diastolic_classification,
+              UPPER(LEFT(p.gender, 1)) gender,
+              disaggregated_age_group(p.birthdate, #{@end_date}) age_group,
+              i.identifier arv_number,
+              latest_drug_order.start_date,
+              GROUP_CONCAT(DISTINCT d.name) drug_names
+          FROM (
+              SELECT MAX(o.obs_datetime) obs_date, o.person_id patient_id
+              FROM obs o
+              INNER JOIN encounter e ON e.encounter_id = o.encounter_id AND e.voided = 0 AND e.program_id = 1 -- HIV PROGRAM
+              WHERE o.concept_id = 5085 -- Systolic blood pressure
+              AND o.voided = 0 AND o.obs_datetime >= #{@start_date} AND o.obs_datetime < #{@end_date} + INTERVAL 1 DAY
+              GROUP BY o.person_id
+          ) AS tpo
+          INNER JOIN obs sys ON sys.concept_id = 5085 AND sys.person_id = tpo.patient_id AND sys.obs_datetime = tpo.obs_date AND sys.voided = 0
+          INNER JOIN obs dia ON dia.concept_id = 5086 AND dia.person_id = tpo.patient_id AND dia.obs_datetime = tpo.obs_date AND dia.voided = 0
+          INNER JOIN person p ON p.person_id = tpo.patient_id AND p.voided = 0
+          INNER JOIN encounter e ON e.encounter_id = dia.encounter_id AND e.program_id = 1 AND e.voided = 0
+          LEFT JOIN patient_identifier i ON i.patient_id = e.patient_id AND i.identifier_type = 4 AND i.voided = 0
+          LEFT JOIN (
+              SELECT o.patient_id, MAX(o.start_date) start_date
+              FROM orders o
+              INNER JOIN drug_order dor ON dor.order_id = o.order_id AND dor.quantity > 0
+              WHERE o.voided = 0
+                  AND o.concept_id IN (SELECT concept_id FROM concept_name WHERE name LIKE '%Hydrochlorothiazide%' OR name LIKE '%Amlodipine%' OR name LIKE '%Enalapril%' OR name LIKE '%Atenolol%')
+                  AND o.start_date >= #{@start_date} AND o.start_date < #{@end_date} + INTERVAL 1 DAY
+              GROUP BY o.patient_id
+          ) AS latest_drug_order ON latest_drug_order.patient_id = tpo.patient_id AND DATE(latest_drug_order.start_date) >= DATE(tpo.obs_date)
+          LEFT JOIN orders ord ON ord.start_date = latest_drug_order.start_date AND ord.patient_id = latest_drug_order.patient_id AND ord.voided = 0 AND ord.concept_id IN (SELECT concept_id FROM concept_name WHERE name LIKE '%Hydrochlorothiazide%' OR name LIKE '%Amlodipine%' OR name LIKE '%Enalapril%' OR name LIKE '%Atenolol%')
+          LEFT JOIN drug_order dor ON dor.order_id = ord.order_id AND dor.quantity > 0
+          LEFT JOIN drug d ON d.drug_id = dor.drug_inventory_id AND d.retired = 0
+          WHERE tpo.patient_id NOT IN (#{external_clients})
+          GROUP BY tpo.patient_id
+          ORDER BY tpo.patient_id ASC
+        SQL
+      end
+
+      def external_clients
+        <<~SQL
+          SELECT obs.person_id FROM obs,
+          (SELECT person_id, Max(obs_datetime) AS obs_datetime, concept_id FROM obs
+          WHERE concept_id IN (SELECT concept_id FROM concept_name WHERE name = 'Type of patient' AND voided = 0)
+          AND DATE(obs_datetime) <= #{@end_date}
+          AND voided = 0
+          GROUP BY person_id) latest_record
+          WHERE obs.person_id = latest_record.person_id
+          AND obs.concept_id = latest_record.concept_id
+          AND obs.obs_datetime = latest_record.obs_datetime
+          AND obs.value_coded IN (SELECT concept_id FROM concept_name WHERE name = 'Drug refill' || name = 'External consultation')
+          AND obs.voided = 0
+        SQL
+      end
+
+      def client_info(data)
+        {
+          patient_id: data['patient_id'],
+          arv_number: data['arv_number'],
+          gender: data['gender'],
+          diastolic: data['diastolic'],
+          systolic: data['systolic']
+        }
+      end
+    end
+    # rubocop:enable Metrics/ClassLength
+  end
+end

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

@@ -0,0 +1,112 @@
+# frozen_string_literal: true
+
+# Cohort report builder class.
+#
+# This class only provides one public method (start_build_report) besides
+# the constructor. This method must be called to build report and save
+# it to database.
+module MalawiHivProgramReports
+  module Clinic
+    class IptCoverage
+      def initialize(start_date:, end_date:)
+        @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')
+      end
+
+      def data
+        patient_ids = []
+        patients = {}
+
+        (on_art_in_reporting_period || []).each do |data|
+          patient_ids << data['patient_id'].to_i
+        end
+
+        return patients if patient_ids.blank?
+
+        data = ipt_dispensations(patient_ids)
+
+        (data || []).each do |record|
+          patient_id = record['patient_id'].to_i
+          age_group = record['age_group']
+          gender = record['gender']
+
+          gender = if gender.blank?
+                     'Unknown'
+                   else
+                     (/F/i.match?(gender) ? 'Female' : 'Male')
+                   end
+
+          patients[age_group] = {} if patients[age_group].blank?
+          patients[age_group][gender] = {} if patients[age_group][gender].blank?
+          patients[age_group][gender][patient_id] = 0 if patients[age_group][gender][patient_id].blank?
+
+          prescription_info = ActiveRecord::Base.connection.select_one <<-SQL
+            SELECT TIMESTAMPDIFF(day, DATE('#{record['start_date']}'), DATE('#{record['auto_expire_date']}')) days;
+          SQL
+
+          next if prescription_info['days'].blank?
+
+          patients[age_group][gender][patient_id] += prescription_info['days'].to_i
+        end
+
+        age_groups = {}
+
+        (patients || {}).each do |keys, values|
+          pats = values
+          (pats || {}).each do |sex, ids|
+            (ids || {}).each do |patient_id, count|
+              next unless count >= 168
+
+              age_groups[keys] = {} if age_groups[keys].blank?
+              age_groups[keys][sex] = [] if age_groups[keys][sex].blank?
+              age_groups[keys][sex] << patient_id
+            end
+          end
+        end
+
+        age_groups
+      end
+
+      private
+
+      def on_art_in_reporting_period
+        ActiveRecord::Base.connection.select_all <<-SQL
+          select
+            `p`.`patient_id` AS `patient_id`, pe.birthdate, pe.gender,
+             cast(patient_date_enrolled(`p`.`patient_id`) as date) AS `date_enrolled`
+          from
+            ((`patient_program` `p`
+            left join `person` `pe` ON ((`pe`.`person_id` = `p`.`patient_id`))
+            left join `patient_state` `s` ON ((`p`.`patient_program_id` = `s`.`patient_program_id`)))
+            left join `person` ON ((`person`.`person_id` = `p`.`patient_id`)))
+          where
+            ((`p`.`voided` = 0)
+                and (`s`.`voided` = 0)
+                and (`p`.`program_id` = 1)
+                and (`s`.`state` = 7))
+                /*and (DATE(`s`.`start_date`) BETWEEN '#{@start_date}' AND '#{@end_date}')*/
+                and pepfar_patient_outcome(p.patient_id, DATE('#{@end_date}')) = 'On antiretrovirals'
+          group by `p`.`patient_id`
+          HAVING date_enrolled IS NOT NULL;
+        SQL
+      end
+
+      def ipt_dispensations(patient_ids)
+        date_six_months_ago = (@start_date.to_date - 6.months).strftime('%Y-%m-%d 00:00:00')
+
+        ActiveRecord::Base.connection.select_all <<-SQL
+          SELECT
+              o.patient_id, birthdate, gender, o.start_date, o.auto_expire_date,
+              disaggregated_age_group(p.birthdate, DATE('#{@end_date}')) age_group
+          FROM person p
+          INNER JOIN orders o ON o.patient_id = p.person_id
+          INNER JOIN drug_order t ON o.order_id = t.order_id
+          INNER JOIN drug d ON d.drug_id = t.drug_inventory_id
+          WHERE o.voided = 0 AND (o.start_date BETWEEN '#{date_six_months_ago}' AND '#{@end_date}')
+          AND d.concept_id = 656 AND o.patient_id IN(#{patient_ids.join(',')})
+          AND t.quantity > 0 ORDER BY o.patient_id;
+        SQL
+      end
+    end
+  end
+end

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

@@ -0,0 +1,69 @@
+# frozen_string_literal: true
+
+module MalawiHivProgramReports
+  module Clinic
+    class IptReport
+      def initialize(start_date:, end_date:)
+        @start_date = start_date
+        @end_date = end_date
+      end
+
+      def ipt_coverage
+        coverage
+      end
+
+      private
+
+      def coverage
+        program_id = ::Program.find_by_name('HIV PROGRAM').id
+        data = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT patient_id FROM encounter
+          WHERE encounter_type = #{::EncounterType.find_by_name('HIV Reception').id}
+          AND 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')}' AND voided = 0
+          AND program_id = #{program_id}
+          GROUP BY DATE(encounter_datetime), patient_id;
+        SQL
+
+        patient_ids = data.map { |p| p['patient_id'].to_i }
+        return { patients: 0, prescribed: 0, dispensed: 0 } if patient_ids.blank?
+
+        ipt_drugs = ::Drug.where('name LIKE (?)', '%Isoniazid%').map(&:drug_id)
+
+        data = ActiveRecord::Base.connection.select_one <<~SQL
+          SELECT count(o.patient_id) AS prescribed FROM orders o
+          INNER JOIN encounter e ON e.encounter_id = o.encounter_id
+          INNER JOIN drug_order i ON i.order_id = o.order_id
+          WHERE o.voided = 0 AND e.patient_id IN(#{patient_ids.join(',')})
+          AND 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 drug_inventory_id IN(#{ipt_drugs.join(',')})#{' '}
+          AND e.program_id = #{program_id};
+        SQL
+
+        #
+        #         data = ::Order.where("start_date BETWEEN ? AND ? AND drug_inventory_id IN(?)
+        #           AND program_id = ? AND orders.patient_id IN(?)",
+        #           @start_date.to_date.strftime('%Y-%m-%d 00:00:00'),
+        #           @end_date.to_date.strftime('%Y-%m-%d 23:59:59'), ipt_drugs, program_id, patient_ids).\
+        #           joins("INNER JOIN encounter e ON e.encounter_id = orders.encounter_id
+        #           INNER JOIN drug_order i ON i.order_id = orders.order_id").count(:patient_id)
+
+        data2 = ActiveRecord::Base.connection.select_one <<~SQL
+          SELECT count(o.patient_id) AS dispensed FROM orders o
+          INNER JOIN encounter e ON e.encounter_id = o.encounter_id
+          INNER JOIN drug_order i ON i.order_id = o.order_id
+          WHERE o.voided = 0 AND e.patient_id IN(#{patient_ids.join(',')})
+          AND 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 drug_inventory_id IN(#{ipt_drugs.join(',')})
+          AND quantity > 0 AND e.program_id = #{program_id};
+        SQL
+
+        prescribed = data['prescribed']
+        dispensed  = data2['dispensed']
+        { patients: patient_ids.length, prescribed:, dispensed: }
+      end
+    end
+  end
+end

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

@@ -0,0 +1,55 @@
+# frozen_string_literal: true
+
+# This class generates the LIMS results report (results delivered electronically)
+module MalawiHivProgramReports
+  module Clinic
+    class LimsResults
+      include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+      attr_reader :start_date, :end_date
+
+      def initialize(start_date:, end_date:, **kwargs)
+        @start_date = start_date
+        @end_date = end_date
+        @occupation = kwargs[:occupation]
+      end
+
+      def find_report
+        data
+      end
+
+      private
+
+      def data
+        ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT o.start_date AS date_ordered, pn.given_name, pn.family_name, pi.identifier AS arv_number, e.patient_id,
+          las.date_received, o.accession_number, CONCAT(COALESCE(res.value_modifier, '='), COALESCE(res.value_text, res.value_numeric)) AS result,
+          cn.name AS test_name, las.acknowledgement_type AS result_delivery_mode, statuses.value_text AS order_status, reason_test.name AS test_reason
+          FROM orders o
+          INNER JOIN lab_lims_order_mappings llom ON llom.order_id = o.order_id
+          LEFT JOIN lims_acknowledgement_statuses las ON las.order_id = o.order_id
+          INNER JOIN encounter e ON e.encounter_id = o.encounter_id AND e.voided = 0 AND (e.program_id = 1 OR e.program_id = 23) -- HIV PROGRAM AND Laboratory program
+          INNER JOIN users u ON u.user_id = o.orderer
+          INNER JOIN person_name pn ON pn.person_id = u.person_id
+          INNER JOIN obs test ON test.person_id = e.patient_id AND test.voided = 0 AND test.order_id = o.order_id AND test.concept_id = 9737 -- 'Test Type'
+          INNER JOIN concept_name cn ON cn.concept_id = test.value_coded AND cn.voided = 0 AND cn.locale_preferred = 1
+          LEFT JOIN patient_identifier pi ON pi.patient_id = e.patient_id AND pi.voided = 0 AND pi.identifier_type = #{identifier_type}
+          LEFT JOIN obs ON obs.person_id = e.patient_id AND obs.voided = 0 AND obs.order_id = o.order_id
+            AND obs.concept_id = 7363 -- 'Lab test result'
+          LEFT JOIN obs statuses ON statuses.order_id = o.order_id AND statuses.voided = 0 AND statuses.concept_id = 10682 -- 'lab order status'
+          LEFT JOIN obs res ON res.obs_group_id = obs.obs_id AND res.voided = 0 AND res.order_id = o.order_id
+          LEFT JOIN obs reason ON reason.order_id = o.order_id AND reason.voided = 0  AND reason.concept_id = 2429 -- 'Reason for test'
+          LEFT JOIN concept_name reason_test ON reason_test.concept_id = reason.value_coded AND reason_test.voided = 0
+          LEFT JOIN (#{current_occupation_query}) AS a ON a.person_id = e.patient_id
+          WHERE DATE(o.start_date) BETWEEN '#{start_date}' AND '#{end_date}' AND o.voided = 0 #{%w[Military Civilian].include?(@occupation) ? 'AND' : ''} #{occupation_filter(occupation: @occupation, field_name: 'value', table_name: 'a', include_clause: false)}
+          GROUP BY o.order_id
+        SQL
+      end
+
+      def identifier_type
+        filling_number = ::GlobalPropertyService.use_filing_numbers?
+
+        filling_number ? 17 : 4
+      end
+    end
+  end
+end

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

@@ -0,0 +1,127 @@
+# frozen_string_literal: true
+
+# Outcome List Report
+module MalawiHivProgramReports
+  module Clinic
+    class OutcomeList
+      include MalawiHivProgramReports::Utils::CommonSqlQueryUtils
+
+      REPORTS = Set.new(%i[transfer_out died stopped]).freeze
+
+      def initialize(start_date:, end_date:, outcome:, **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]
+        @report = load_report outcome.downcase.split.join('_')
+      end
+
+      def get_list
+        @report
+      end
+
+      private
+
+      def start_date
+        ActiveRecord::Base.connection.quote(@start_date)
+      end
+
+      def end_date
+        ActiveRecord::Base.connection.quote(@end_date)
+      end
+
+      def load_report(name)
+        name = name.to_sym
+
+        raise "Invalid report: #{name}" unless REPORTS.include?(name)
+
+        method(name).call
+      end
+
+      def transfer_out
+        outcome_query 'Patient transferred out'
+      end
+
+      def died
+        outcome_query 'Patient died'
+      end
+
+      def stopped
+        outcome_query 'Treatment stopped'
+      end
+
+      def outcome_query(outcome_state)
+        report_type = 'moh'
+        MalawiHivProgramReports::Moh::CohortBuilder.new(outcomes_definition: report_type).init_temporary_tables(
+          @start_date.to_date, @end_date.to_date, @occupation
+        )
+
+        transfer_out_to_location_sql = ''
+        transfer_out_to_location_name_sql = ''
+        if /Transfer/i.match?(outcome_state)
+          concept_id = ::ConceptName.find_by_name('Transfer out to location').concept_id
+          transfer_out_to_location_name_sql = ' ,to_location.value_text transferred_out_to'
+          transfer_out_to_location_sql = ' LEFT JOIN obs to_location ON to_location.person_id = e.patient_id'
+          transfer_out_to_location_sql += " AND to_location.concept_id = #{concept_id} AND to_location.voided = 0"
+        end
+
+        data = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT
+            e.patient_id, i.identifier, e.birthdate,
+            e.gender, n.given_name, n.family_name,
+            art_reason.name art_reason, a.value cell_number,
+            s3.state_province district, s3.county_district ta,
+            s3.city_village village, TIMESTAMPDIFF(year, DATE(e.birthdate), DATE('#{@end_date}')) age,
+            pp.date_enrolled, pp.date_completed,
+            s2.start_date outcome_date, s2.end_date, s2.state
+            #{transfer_out_to_location_name_sql}
+          FROM temp_earliest_start_date e
+          INNER JOIN temp_patient_outcomes o ON e.patient_id = o.patient_id
+          LEFT JOIN patient_identifier i ON i.patient_id = e.patient_id
+            AND i.voided = 0 AND i.identifier_type = 4
+          INNER JOIN person_name n ON n.person_id = e.patient_id AND n.voided = 0
+          LEFT JOIN person_attribute a ON a.person_id = e.patient_id
+            AND a.voided = 0 AND a.person_attribute_type_id = 12
+          LEFT JOIN person_address s3 ON s3.person_id = e.patient_id
+          LEFT JOIN concept_name art_reason ON art_reason.concept_id = e.reason_for_starting_art
+          #{transfer_out_to_location_sql}
+          INNER JOIN patient_program pp ON pp.patient_id = e.patient_id AND pp.program_id = 1
+          INNER JOIN patient_state s2 ON s2.patient_program_id = pp.patient_program_id
+          INNER JOIN program_workflow_state ws ON ws.program_workflow_state_id = s2.state
+          INNER JOIN program_workflow w ON w.program_workflow_id = ws.program_workflow_id
+          INNER JOIN concept_name n2 ON n2.concept_id = ws.concept_id
+          WHERE o.cum_outcome = '#{outcome_state}'
+            AND pp.voided = 0
+            AND s2.voided = 0
+            AND s2.start_date
+          BETWEEN '#{@start_date}' AND '#{@end_date}' AND s2.state NOT IN(7,1, 12)
+          GROUP BY e.patient_id ORDER BY e.patient_id, n.date_created DESC;
+        SQL
+
+        patients = []
+
+        (data || []).each do |person|
+          patients << {
+            patient_id: person['patient_id'],
+            given_name: person['given_name'],
+            family_name: person['family_name'],
+            birthdate: person['birthdate'],
+            gender: person['gender'],
+            arv_number: person['arv_number'],
+            outcome: 'Defaulted',
+            art_reason: person['art_reason'],
+            cell_number: person['cell_number'],
+            district: person['district'],
+            ta: person['ta'],
+            village: person['village'],
+            current_age: person['age'],
+            identifier: person['identifier'],
+            transferred_out_to: person['transferred_out_to'] || 'N/A',
+            outcome_date: person['outcome_date']&.to_date || 'N/A'
+          }
+        end
+
+        patients
+      end
+    end
+  end
+end

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

@@ -0,0 +1,57 @@
+# frozen_string_literal: true
+
+# Returns all patients alive and on treatment within a given
+# time period (Tx Curr).
+module MalawiHivProgramReports
+  module Clinic
+    class PatientsAliveAndOnTreatment
+      attr_reader :start_date, :end_date
+
+      include MalawiHivProgramReports::Utils::ConcurrencyUtils
+
+      def initialize(start_date:, end_date:, outcomes_definition: 'moh', rebuild_outcomes: true, **kwargs)
+        @start_date = start_date
+        @end_date = end_date
+        @rebuild_outcomes = rebuild_outcomes
+        @outcomes_definition = outcomes_definition
+        @occupation = kwargs[:occupation]
+        @location = kwargs[:location]
+      end
+
+      ##
+      # Repopulates temp_patient_outcomes and temp_earliest_start_date tables.
+      #
+      # The data in temp_patient_outcomes can be used to quickly find patients
+      # with various outcomes.
+      def refresh_outcomes_table
+        logger.debug('Initialising cohort temporary tables...')
+        MalawiHivProgramReports::Moh::CohortBuilder.new(outcomes_definition: @outcomes_definition, location: @location)
+                                                   .init_temporary_tables(@start_date, @end_date, @occupation)
+      end
+
+      def find_report
+        query.map(&:patient_id)
+      end
+
+      def query
+        with_lock(Cohort::LOCK_FILE) do
+          refresh_outcomes_table if @rebuild_outcomes || !outcomes_table_exists?
+
+          ::Patient.find_by_sql <<~SQL
+            SELECT patient_id FROM temp_patient_outcomes WHERE cum_outcome LIKE 'On antiretrovirals'
+          SQL
+        end
+      end
+
+      private
+
+      def outcomes_table_exists?
+        ActiveRecord::Base.connection.table_exists?(:temp_patient_outcomes)
+      end
+
+      def logger
+        Rails.logger
+      end
+    end
+  end
+end

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

@@ -0,0 +1,39 @@
+# frozen_string_literal: true
+
+module MalawiHivProgramReports
+  module Clinic
+    class PatientsDueForViralLoad
+      attr_accessor :start_date, :end_date
+
+      def initialize(start_date:, end_date:, **_kwargs)
+        @start_date = start_date
+        @end_date = end_date
+      end
+
+      def find_report
+        patients_alive_and_on_treatment.select do |patient_id|
+          patient_viral_load_due?(patient_id)
+        end
+      end
+
+      private
+
+      def patient_viral_load_due?(patient_id)
+        reminder = viral_load_reminder(patient_id)
+        reminder[:eligibile] # Yes its spelt eligibile not eligible...
+      end
+
+      def patients_alive_and_on_treatment
+        PatientsAliveAndOnTreatment
+          .new(start_date:, end_date:)
+          .find_report
+      end
+
+      def viral_load_reminder(patient_id)
+        ArtService::VlReminder
+          .new(patient_id:, date: end_date)
+          .vl_reminder_info
+      end
+    end
+  end
+end