define "HIV Status Positive Condition":
  [Condition: Concepts."HIV-positive - HIV.B.DE116"] C
    where C.clinicalStatus ~ ConceptsCustom."active"
      and exists(C.category CC where CC ~ ConceptsCustom."encounter-diagnosis")
    sort by start of onset.toInterval()

define "HIV Status Positive Condition":
  Elements."HIV Status Positive Condition" C
  where C.onset before end of "Measurement Period"

/* End of HIV-inconclusive */

/*
@dataElement: HIV.B.DE115 - HIV status
@activity: HIV.B7 Test for HIV using testing algorithm
@description: HIV status reported after applying the national HIV testing algorithm. No single HIV test can provide an HIV-positive diagnosis.
*/
define "HIV Status Observation":
  [Observation: Concepts."HIV status"] O
    where O.status in { 'final', 'amended', 'corrected' }

define "HIV Status Positive Observation":
"HIV Status Observation" O
    where O.value ~ Concepts."HIV-positive - HIV.B.DE116"
      sort by start of effective.toInterval()

define "HIV Status Positive Observation":
  Elements."HIV Status Positive Observation" O
  where O.issued before end of "Measurement Period"
  or O.effective.toInterval() starts before end of "Measurement Period"

define "Has HIV-positive Status":
  exists "HIV Status Positive Condition"
  or exists "HIV Status Positive Observation"

/* End of Reason ART stopped H.DE74 */

/*
@dataElement: HIV.H.DE75 - Toxicity/side effects
@activity: HIV.H3 Record outreach and result
@description: Client stopped ART because of toxicity/side effects
*/

define "Toxicity/side effects H.DE75":
  exists([MedicationStatement] MS
    where MS.status in {'stopped'}
    and exists(MS.reasonCode C where C ~ Concepts."On ART - HIV.H.DE47")
    and exists(MS.statusReason R where R ~ Concepts."Toxicity/side effects - HIV.H.DE75")
    and start of MS.effective.toInterval() during "Measurement Period")

/* End of Refused stopped treatment */

/*
@dataElement: HIV.H.DE47 - On ART
@activity: HIV.H3 Record outreach and result
@description: Client is currently taking ART 
*/

define "On ART H.DE47":
    [MedicationStatement] MS
    where exists(MS.reasonCode C where C ~ Concepts."On ART - HIV.H.DE47")
    sort by start of effective.toInterval()

/* End of Refused stopped treatment */

/*
@dataElement: HIV.H.DE47 - On ART
@activity: HIV.H3 Record outreach and result
@description: Client is currently taking ART 
*/
define "On ART H.DE47":
  exists(Elements."On ART H.DE47" ART
   where ART.effective.toInterval() during "Measurement Period"
   )

/* End of Unexpected adverse drug reaction */

/*
HIV.D.DE485
New regimen after switch to second-line regimen
*/

define "New regimen after switch to second-line regimen":
  [MedicationStatement] MS
    where exists(MS.reasonCode C where C ~ Concepts."New regimen after switch to second-line regimen")
    sort by start of effective.toInterval()

/* End of Reason ART stopped H.DE74 */

/*
@dataElement: HIV.H.DE75 - Toxicity/side effects
@activity: HIV.H3 Record outreach and result
@description: Client stopped ART because of toxicity/side effects
*/

define "Toxicity/side effects H.DE75":
  [MedicationStatement] MS
    where MS.status in {'stopped'}
    and exists(MS.reasonCode C where C ~ Concepts."On ART - HIV.H.DE47")
    and exists(MS.statusReason R where R ~ Concepts."Toxicity/side effects - HIV.H.DE75")
    sort by start of effective.toInterval()

/*
HIV.D.DE491
New regimen after switch to third-line regimen
*/

define "New regimen after switch to third-line regimen":
  [MedicationStatement] MS
    where exists(MS.reasonCode C where C ~ Concepts."New regimen after switch to third-line regimen")
    sort by start of effective.toInterval()

/*
HIV.D.DE489	New regimen(s) after substitution within second-line regimen
*/

define "New regimen after substitution within second-line regimen":
  [MedicationStatement] MS
    where exists(MS.reasonCode C where C ~ Concepts."New regimen after switch to second-line regimen")
    sort by start of effective.toInterval()

/*
HIV.D.DE495	New regimen(s) after substitution within third-line regimen
*/

define "New regimen after substitution within third-line regimen":
  [MedicationStatement] MS
    where exists(MS.reasonCode C where C ~ Concepts."New regimen after switch to third-line regimen")
    sort by start of effective.toInterval()

/**
 * Numerator
 * 
 * Definition: Number of ART patients who have stopped treatment or switched regimen due to toxicity in the reporting period
 * Calculation: COUNT of clients with "HIV status"='HIV-positive' with a "Date ART stopped" in the reporting period AND "Reason ART stopped"='Toxicity/side effects' | PLUS | COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True AND either "Date of switch to second-line regimen" OR "Date of switch to third-line regimen" in the reporting period with a "Reason for regimen switch"='Toxicity/side effects'  | PLUS | COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True AND either "Date(s) of substitution within second-line regimen" OR "Date(s) of substitution within third-line regimen" in the reporting period AND "Reason for ARV drug regimen substitution"='Toxicity/side effects'
 */

define "Numerator":
  (HIE."Has HIV-positive Status"
  and HIE."Toxicity/side effects H.DE75")
  and ((
    HIE."Has HIV-positive Status" 
    and HIE."On ART H.DE47"
    and 
    (exists(HE."New regimen after switch to second-line regimen" R
    with HE."Toxicity/side effects H.DE75" T
    such that R.partOf.references(T)
    where R.effective.toInterval() during "Measurement Period"
    )
    or 
    (
    exists(HE."New regimen after switch to third-line regimen" R
    with HE."Toxicity/side effects H.DE75" T
    such that R.partOf.references(T)
    where R.effective.toInterval() during "Measurement Period"  
    )
    )
  )
  )
  or
  (
    HIE."Has HIV-positive Status"
    and HIE."On ART H.DE47"
    and 
    (exists(HE."New regimen after substitution within second-line regimen" R
    with HE."Toxicity/side effects H.DE75" T
    such that R.partOf.references(T)
    where R.effective.toInterval() during "Measurement Period"
    )
    or 
    (
    exists(HE."New regimen after substitution within third-line regimen" R
    with HE."Toxicity/side effects H.DE75" T
    such that R.partOf.references(T)
    where R.effective.toInterval() during "Measurement Period"  
    )
    )
  )
  )

  )

/**
 * Denominator
 *
 * Definition: Number of ART patients in the reporting period
 * Calculation: COUNT of clients with "HIV status"='HIV-positive' AND "On ART"=True within the reporting period
 */

define "Denominator":
  HIE."Has HIV-positive Status"
    and HIE."On ART H.DE47"

/* Populations */

/*
 *Initial Population
 */

define "Initial Population":
  true

/*
@dataElement: HIV.A.DE18 - Gender
@activity: HIV.A6.1 Review sociodemographic data with client | HIV.A5 Create new client record
@description: Gender of the client
*/

/*
 * By Administrative Gender of Patient Stratifier
 * Need to expand codes
 */

define "By Administrative Gender Stratifier":
  case 
      when Patient.gender = 'male' then Concepts."Male"
      when Patient.gender = 'female' then Concepts."Female"
      when Patient.gender = 'transgender female' then Concepts."Transgender female"
      when Patient.gender = 'transgender male' then Concepts."Transgender male"
      else Concepts."Other - HIV.A.DE23"
  end

/* End of Visit date A.DE3 */

/*
@dataElement: HIV.A.DE17 - Age
@activity: HIV.A6.1 Review sociodemographic data with client | HIV.A5 Create new client record
@description: Calculated age (number of years) of the client based on date of birth
*/
define "Age In Years":
  AgeInYearsAt(start of "Measurement Period")

//(<0–4, 5–9, 10–14, 15-19, >19 years)
define "By Age Stratifier 6":
  case 
      when "Age In Years" < 5  then '<0–4'
      when "Age In Years"<= 9 then '5–9'
      when "Age In Years" <= 14 then '10–14'
      when "Age In Years" <= 19 then '15-19'
      when "Age In Years" >= 20 then '>19'
      else null
  end

// Geographic Region
define "By Geographic Region Stratifier":
    First(Patient.address A where A.use in { 'home' }).state

/* End of Key population member B.DE49 */

/*
@dataElement: HIV.B.DE50 - Key population member type
@activity: HIV.B6 Capture or update client history
@description: The type of key population that the client is included in
*/
define "Key population member type Observation":
  [Observation: Concepts."Key population member - HIV.B.DE49"] O
    where O.status in { 'final', 'amended', 'corrected' }
    and exists(O.category OC where OC ~ ConceptsCustom."social-history")

define "Key population member type Observation":
  Elements."Key population member type Observation" O
    where O.effective.toInterval() before end of "Measurement Period"
    or O.issued before end of "Measurement Period"

// Stratifier
define patientGroups:
  "Key population member type Observation" O
  return Combine(O.code.coding.code, ':')

/* End of Current ART regimen */

/*
@dataElement: HIV.D.DE77 - Preferred first-line ART regimen
@activity: HIV.D8 Capture or update client history
@description: The preferred first-line ART regimen for the client according to WHO (or national) guidelines
*/

define "Preferred first-line ART regimen":
[MedicationStatement] MS
    where MS.status = 'completed'
    and MS.medication ~ Concepts."Preferred first-line ART regimen"

/* End of Preferred first-line ART regimen */

/*
@dataElement: HIV.D.DE78 - Alternative first-line ART regimen
@activity: HIV.D8 Capture or update client history
@description: The alternative first-line ART regimen for the client according to WHO (or national) guidelines
*/

define "Alternative first-line ART regimen":
  [MedicationStatement] MS
    where MS.status = 'completed'
    and MS.medication ~ Concepts."Alternative first-line ART regimen"

/* End of Alternative first-line ART regimen */

/*
@dataElement: HIV.D.DE79 - First-line ART regimen under special circumstances
@activity: HIV.D8 Capture or update client history
@description: The first-line ART regimen for the client under special circumstances according to WHO (or national) guidelines
*/

define "First-line ART regimen under special circumstances":
    [MedicationStatement] MS
    where MS.status = 'completed'
    and MS.medication ~ Concepts."First-line ART regimen under special circumstances"

/* End of First-line ART regimen under special circumstances */

/*
@dataElement: HIV.D.DE80 - Preferred second-line ART regimen
@activity: HIV.D8 Capture or update client history
@description: The preferred second-line ART regimen for the client according to WHO (or national) guidelines
*/

define "Preferred second-line ART regimen":
    [MedicationStatement] MS
    where MS.status = 'completed'
    and MS.medication ~ Concepts."Preferred second-line ART regimen"

/* End of Preferred second-line ART regimen */

/*
@dataElement: HIV.D.DE81 - Alternative second-line ART regimen
@activity: HIV.D8 Capture or update client history
@description: The alternative second-line ART regimen for the client according to WHO (or national) guidelines
*/

define "Alternative second-line ART regimen":
    [MedicationStatement] MS
    where MS.status = 'completed'
    and MS.medication ~ Concepts."Alternative second-line ART regimen"

/* End of Restarting ART */

/*
@dataElement: HIV.D.DE75 - Current ART regimen
@activity: HIV.D8 Capture or update client history
@description: The current ART regimen the client is taking
*/

define "Current ART regimen":
  case 
      when exists(Elements."Preferred first-line ART regimen" MS where MS.effective.toInterval() during "Measurement Period") then Concepts."Preferred first-line ART regimen"
      when exists(Elements."Alternative first-line ART regimen" MS where MS.effective.toInterval() during "Measurement Period") then Concepts."Alternative first-line ART regimen"
      when exists(Elements."First-line ART regimen under special circumstances" MS where MS.effective.toInterval() during "Measurement Period") then Concepts."First-line ART regimen under special circumstances"
      when exists(Elements."Preferred second-line ART regimen" MS where MS.effective.toInterval() during "Measurement Period") then Concepts."Preferred second-line ART regimen"
      when exists(Elements."Alternative second-line ART regimen" MS where MS.effective.toInterval() during "Measurement Period") then Concepts."Alternative second-line ART regimen"
      else null
  end

/* End of Type of treatment-limiting toxicity */

/*
@dataElement: HIV.D.DE467 - Gastrointestinal
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to GI issues (nausea, diarrhoea, abdominal pain, vomiting)
*/

define "Gastrointestinal":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Gastrointestinal"

/* End of Type of treatment-limiting toxicity */

/*
@dataElement: HIV.D.DE467 - Gastrointestinal
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to GI issues (nausea, diarrhoea, abdominal pain, vomiting)
*/

define "Gastrointestinal":
  exists Elements."Gastrointestinal" AE where AE.date during "Measurement Period"

/* End of Gastrointestinal */

/*
@dataElement: HIV.D.DE468 - Skin issues
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to skin issues (rash, hypersensitivity reaction)
*/

define "Skin issues":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Skin issues"

/* End of Gastrointestinal */

/*
@dataElement: HIV.D.DE468 - Skin issues
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to skin issues (rash, hypersensitivity reaction)
*/

define "Skin issues":
  exists Elements."Skin issues" AE where AE.date during "Measurement Period"

/* End of Skin issues */

/*
@dataElement: HIV.D.DE469 - Peripheral neuropathy
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to peripheral neuropathy (burning/numbness/ tingling)
*/

define "Peripheral neuropathy":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~  Concepts."Peripheral neuropathy"

/* End of Skin issues */

/*
@dataElement: HIV.D.DE469 - Peripheral neuropathy
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to peripheral neuropathy (burning/numbness/ tingling)
*/

define "Peripheral neuropathy":
  exists Elements."Peripheral neuropathy" AE where AE.date during "Measurement Period"

/* End of Peripheral neuropathy */

/*
@dataElement: HIV.D.DE470 - Central nervous system symptoms
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to central nervous system symptoms (dizzy, anxiety, nightmare, depression, seizures)
*/

define "Central nervous system symptoms":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Central nervous system symptoms"

/* End of Peripheral neuropathy */

/*
@dataElement: HIV.D.DE470 - Central nervous system symptoms
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to central nervous system symptoms (dizzy, anxiety, nightmare, depression, seizures)
*/

define "Central nervous system symptoms":
  exists Elements."Central nervous system symptoms" AE where AE.date during "Measurement Period"

/* End of Central nervous system symptoms */

/*
@dataElement: HIV.D.DE471 - Weight gain
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to weight gain
*/

define "Weight gain":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Weight gain"

/* End of Central nervous system symptoms */

/*
@dataElement: HIV.D.DE471 - Weight gain
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to weight gain
*/

define "Weight gain":
  exists Elements."Weight gain" AE where AE.date during "Measurement Period"

/* End of Weight gain */

/*
@dataElement: HIV.D.DE472 - Hepatic dysfunction
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to hepatic dysfunction (jaundice)
*/

define "Hepatic dysfunction":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Hepatic dysfunction"

/* End of Weight gain */

/*
@dataElement: HIV.D.DE472 - Hepatic dysfunction
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to hepatic dysfunction (jaundice)
*/

define "Hepatic dysfunction":
  exists Elements."Hepatic dysfunction" AE where AE.date during "Measurement Period"

/* End of Hepatic dysfunction */

/*
@dataElement: HIV.D.DE473 - Haematological disorders
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to haematological (anaemia, neutropenia) disorders
*/

define "Haematological disorders":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Haematological disorders"

/* End of Hepatic dysfunction */

/*
@dataElement: HIV.D.DE473 - Haematological disorders
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to haematological (anaemia, neutropenia) disorders
*/

define "Haematological disorders":
  exists Elements."Haematological disorders" AE where AE.date during "Measurement Period"

/* End of Haematological disorders */

/*
@dataElement: HIV.D.DE474 - Fatigue
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to fatigue
*/

define "Fatigue":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Fatigue"

/* End of Haematological disorders */

/*
@dataElement: HIV.D.DE474 - Fatigue
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to fatigue
*/

define "Fatigue":
  exists Elements."Fatigue" AE where AE.date during "Measurement Period"

/* End of Fatigue */

/*
@dataElement: HIV.D.DE475 - Headache
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to headache
*/

define "Headache D.DE475":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~  Concepts."Headache - HIV.D.DE475"

/* End of Fatigue */

/*
@dataElement: HIV.D.DE475 - Headache
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to headache
*/
 
define "Headache D.DE475":
  exists Elements."Headache D.DE475" AE where AE.date during "Measurement Period"

/* End of Headache D.DE475 */

/*
@dataElement: HIV.D.DE476 - Bone dysfunction
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to bone dysfunction (fractures, osteopenia)
*/

define "Bone dysfunction":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~  Concepts."Bone dysfunction"

/* End of Headache D.DE475 */

/*
@dataElement: HIV.D.DE476 - Bone dysfunction
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to bone dysfunction (fractures, osteopenia)
*/

define "Bone dysfunction":
  exists Elements."Bone dysfunction" AE where AE.date during "Measurement Period"

/* End of Bone dysfunction */

/*
@dataElement: HIV.D.DE477 - Metabolic symptoms
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to metabolic symptoms (body fat changes, hyperglycaemia, dyslipidaemia)
*/

define "Metabolic symptoms":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Metabolic symptoms"

/* End of Bone dysfunction */

/*
@dataElement: HIV.D.DE477 - Metabolic symptoms
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to metabolic symptoms (body fat changes, hyperglycaemia, dyslipidaemia)
*/
 
define "Metabolic symptoms":
  exists Elements."Metabolic symptoms" AE where AE.date during "Measurement Period"

/* End of Metabolic symptoms */

/*
@dataElement: HIV.D.DE478 - Kidney dysfunction
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to kidney dysfunction (nephrolithiasis, renal insufficiency)
*/

define "Kidney dysfunction":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~  Concepts."Kidney dysfunction"

/* End of Metabolic symptoms */

/*
@dataElement: HIV.D.DE478 - Kidney dysfunction
@activity: HIV.D21 Determine regimen and treatment options
@description: Treatment-limiting toxicity due to kidney dysfunction (nephrolithiasis, renal insufficiency)
*/
 
define "Kidney dysfunction":
  exists Elements."Kidney dysfunction" AE where AE.date during "Measurement Period"

/* End of Kidney dysfunction */

/*
@dataElement: HIV.D.DE479 - Unexpected adverse drug reaction
@activity: HIV.D21 Determine regimen and treatment options
@description: Client experienced an unexpected adverse drug reaction
*/

define "Unexpected adverse drug reaction":
  [AdverseEvent] AE 
  where AE.actuality = 'actual'
  and AE.event ~ Concepts."Unexpected adverse drug reaction"

/* End of Kidney dysfunction */

/*
@dataElement: HIV.D.DE479 - Unexpected adverse drug reaction
@activity: HIV.D21 Determine regimen and treatment options
@description: Client experienced an unexpected adverse drug reaction
*/
 
define "Unexpected adverse drug reaction":
  exists Elements."Unexpected adverse drug reaction" AE where AE.date during "Measurement Period"

/* End of Number of days medications prescribed */

/*
@dataElement: HIV.D.DE466 - Type of treatment-limiting toxicity
@activity: HIV.D21 Determine regimen and treatment options
@description: Type of treatment-limiting toxicity experienced by client. Treatment-limiting toxicity is defined as a serious adverse drug reaction that results in drug discontinuation or substitution. In addition, any reaction that leads to treatment interruption or requires changing the drug or regimen because of an adverse drug reaction is also considered a serious adverse drug reaction.
*/

define "Type of treatment-limiting toxicity":
    case 
        when "Gastrointestinal" then  Concepts."Gastrointestinal"
        when "Skin issues" then  Concepts."Skin issues"
        when "Peripheral neuropathy" then  Concepts."Peripheral neuropathy"
           when "Central nervous system symptoms" then  Concepts."Central nervous system symptoms"
            when "Weight gain" then  Concepts."Weight gain"
             when "Hepatic dysfunction" then  Concepts."Hepatic dysfunction"
              when "Haematological disorders" then  Concepts."Haematological disorders"
               when "Fatigue" then  Concepts."Fatigue"
               when "Headache D.DE475" then  Concepts."Headache - HIV.D.DE475"
               when "Bone dysfunction" then  Concepts."Bone dysfunction"
               when "Metabolic symptoms" then  Concepts."Metabolic symptoms"
               when "Kidney dysfunction" then  Concepts."Kidney dysfunction"
                              when "Unexpected adverse drug reaction" then  Concepts."Unexpected adverse drug reaction"
              else null
    end

/* End of Facility-level testing */

/*
@dataElement: HIV.B.DE29 - Currently pregnant
@activity: HIV.B6 Capture or update client history
@description: Client is currently pregnant
*/

define "Currently pregnant B.DE29":
  [Condition: Concepts."Currently pregnant - HIV.B.DE29"] C
  sort by start of prevalenceInterval()

/* End of Facility-level testing */

/*
@dataElement: HIV.B.DE29 - Currently pregnant
@activity: HIV.B6 Capture or update client history
@description: Client is currently pregnant
*/

define "Currently pregnant B.DE29":
  Elements."Currently pregnant B.DE29" C
    where C.prevalenceInterval() during "Measurement Period"

/* End of Currently pregnant B.DE29 */

/*
@dataElement: HIV.B.DE32 - Breastfeeding
@activity: HIV.B6 Capture or update client history
@description: Infant is being breastfed by mother
*/

define "Breastfeeding B.DE32":
  [Observation: Concepts."Breastfeeding - HIV.B.DE32"] O
    where O.status in { 'final', 'amended', 'corrected' }
      and O.value is true

/* End of Currently pregnant B.DE29 */

/*
@dataElement: HIV.B.DE32 - Breastfeeding
@activity: HIV.B6 Capture or update client history
@description: Infant is being breastfed by mother
*/

define "Breastfeeding B.DE32":
  Elements."Breastfeeding B.DE32" O
    where O.effective.toInterval() during "Measurement Period"

define "pregnancy stratifier":
  case
    when exists("Currently pregnant B.DE29") then Concepts."Currently pregnant - HIV.B.DE29"
    when exists("Breastfeeding B.DE32") then Concepts."Breastfeeding - HIV.B.DE32"
    else null
  end

define "Stratification":
 HIE."By Administrative Gender Stratifier".code 
  + ':' + HIE."By Age Stratifier 6"
+ ':' + HIE."By Geographic Region Stratifier"
+ Combine(HIE.patientGroups, ':')
+ HIE."Current ART regimen".code 
+ HIE."Type of treatment-limiting toxicity".code
+ HIE."pregnancy stratifier".code

define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

define function ToDateTime(value dateTime): value.value

define function ToString(value ObservationStatus): value.value

define function ToDateTime(value instant): value.value

define function ToString(value MedicationStatementStatus): value.value

/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<FHIR.Reference>, resource FHIR.Resource):
  exists (references R where R.references(resource))

/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference FHIR.Reference, resource FHIR.Resource):
  resource.id = Last(Split(reference.reference, '/'))

define function ToString(value string): value.value

define function ToString(value AdministrativeGender): value.value

define function ToString(value AddressUse): value.value

define function ToString(value AdverseEventActuality): value.value

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition resource.
@comment: Uses the toInterval and toAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition.
*/
define fluent function prevalenceInterval(condition Condition):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
  (end of condition.abatementInterval()) abatementDate
    return 
	  if abatementDate is null then
        Interval[start of condition.onset.toInterval(), abatementDate)
      else
        Interval[start of condition.onset.toInterval(), abatementDate]

/*
@description: Returns an interval representing the normalized Abatement of a given Condition resource.
@comment: NOTE: Due to the complexity of determining an interval from a String, this function will throw
a run-time exception if used with a Condition instance that has a String as the abatement value.
*/
define fluent function abatementInterval(condition Condition):
  if condition.abatement is FHIR.dateTime then
    Interval[FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime), FHIRHelpers.ToDateTime(condition.abatement as FHIR.dateTime)]
  else if condition.abatement is FHIR.Period then
    FHIRHelpers.ToInterval(condition.abatement as FHIR.Period)
  else if condition.abatement is FHIR.string then
    Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
  else if condition.abatement is FHIR.Age then
    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age),
      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(condition.abatement as FHIR.Age) + 1 year)
  else if condition.abatement is FHIR.Range then
    Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).low),
      FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((condition.abatement as FHIR.Range).high) + 1 year)
  else if condition.abatement is FHIR.boolean then
    Interval[end of condition.onset.toInterval(), condition.recordedDate)
  else 
    null

define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function ToDate(value date): value.value

define function ToQuantity(quantity FHIR.Quantity):
    case
        when quantity is null then null
        when quantity.value is null then null
        when quantity.comparator is not null then
            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
        else
            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
    end

define function ToCalendarUnit(unit System.String):
    case unit
        when 'ms' then 'millisecond'
        when 's' then 'second'
        when 'min' then 'minute'
        when 'h' then 'hour'
        when 'd' then 'day'
        when 'wk' then 'week'
        when 'mo' then 'month'
        when 'a' then 'year'
        else unit
    end

define function ToBoolean(value boolean): value.value