Screen readers do not indicate when text is underlined, similar to how it is with struck out text. The underlined and struck out text are read as plain text by screen readers. Underlined text carries no semantic meaning, and if the intention is to emphasize certain words, then the <em> or <strong> tags can be considered for use.
If you would like to retain underlined text as it appears in a print version of a title, you can use CSS: text-decoration:underline; — this is preferred over in-line styling.
To indicate when text is underlined or struck out for screen reader users, those passages of text can be captured as images and the alt-text or extended description can note which words are underlined or struck out. It is one solution, albeit not the most efficient.